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Continuity of Community-Based Healthcare Provision During COVID-19: A Multi-Country Interrupted Time Series Analysis

28 Pages Posted: 9 Apr 2021

See all articles by Madeleine Ballard

Madeleine Ballard

Mount Sinai Health System - Arnhold Institute for Global Health; Community Health Impact Coalition

Helen Elizabeth Olsen

Medic

Anoushka Millear

Medic

Jane Yang

Muso

Caroline Whidden

Muso

Amanda Yembrick

Medic

Dianne Thakura

Living Goods, Nairobi

Afra Nuwasiima

Living Goods, Kampala

Molly Christiansen

Living Goods, San Francisco

Daniele J. Ressler

Lwala Community Alliance

Wycliffe Okoth Omwanda

Lwala Community Alliance

Diego Lassala

Muso

Daniel Palazuelos

Harvard University - Brigham and Women's Hospital

Carey Westgate

Community Health Impact Coalition

Fabien Munyaneza

Abwenzi Pa Za Umoyo - Partners In Health

More...

Abstract

Background: Pandemics often precipitate declines in essential health service utilization, which can ultimately kill more people than the disease outbreak itself. There is some evidence, however, that the presence of adequately-supported community health workers (CHWs), i.e.  financially remunerated, trained, supplied, and supervised in line with WHO guidelines, may blunt the impact of health system shocks. Yet, adequate support for CHWs is often missing or uneven across countries. This study assesses whether adequately-supported CHWs can maintain the continuity of essential community-based health service provision during the COVID-19 pandemic. 

Methods: Interrupted time series analysis. Monthly routine data from twenty-seven districts across four countries in sub-Saharan Africa were extracted from CHW and facility reports for the period January 2018 to September 2020. Descriptive analysis, null hypothesis testing, and segmented regression analysis were used to assess the presence and magnitude of a possible disruption in care utilization after the earliest reported cases of COVID-19. 

Findings: CHWs across all sites were supported in line with the WHO Guideline and received COVID-19 adapted protocols, training and personal protective equipment within 45 days after the first case in country. We found no disruptions to the coverage of proactive household visits or iCCM assessments provided by these prepared and protected CHWs, as well as no disruptions to the speed with which iCCM was received, pregnancies were registered, or postnatal care received. We found that coverage of facilities-based deliveries was disrupted following the pandemic.  

Interpretation: CHWs who were equipped and prepared for the pandemic were able to maintain speed and coverage of community-delivered care during the pandemic period. Given that the majority of CHWs globally remain unpaid and largely unsupported, this paper suggests that the opportunity cost of not professionalizing CHWs may be larger than previously estimated, particularly in light of the inevitability of future pandemics.

Funding Statement: None to declare.

Declaration of Interests: None to declare.

Ethics Approval Statement: The study team received an IRB exemption from the University of Washington’s Human Subjects Division.

Keywords: community health workers, COVID-19, continuity of care

Suggested Citation

Ballard, Madeleine and Olsen, Helen Elizabeth and Millear, Anoushka and Yang, Jane and Whidden, Caroline and Yembrick, Amanda and Thakura, Dianne and Nuwasiima, Afra and Christiansen, Molly and Ressler, Daniele J. and Omwanda, Wycliffe Okoth and Lassala, Diego and Palazuelos, Daniel and Westgate, Carey and Munyaneza, Fabien, Continuity of Community-Based Healthcare Provision During COVID-19: A Multi-Country Interrupted Time Series Analysis. Available at SSRN: https://ssrn.com/abstract=3820544 or http://dx.doi.org/10.2139/ssrn.3820544

Madeleine Ballard (Contact Author)

Mount Sinai Health System - Arnhold Institute for Global Health ( email )

1216 5th Ave
New York, NY 10029
United States
+1-212-824-7950 (Phone)
+1-212-824-7995 (Fax)

Community Health Impact Coalition

NY
United States

Helen Elizabeth Olsen

Medic ( email )

San Francisco, CA
United States

Anoushka Millear

Medic ( email )

San Francisco, CA
United States

Jane Yang

Muso

Bamako
Mali

Caroline Whidden

Muso ( email )

Bamako
Mali

Amanda Yembrick

Medic ( email )

San Francisco, CA
United States

Dianne Thakura

Living Goods, Nairobi ( email )

Nairobi
Kenya

Afra Nuwasiima

Living Goods, Kampala ( email )

Kampala
Uganda

Molly Christiansen

Living Goods, San Francisco

San Francisco, CA
United States

Daniele J. Ressler

Lwala Community Alliance ( email )

Rongo
Kenya

Wycliffe Okoth Omwanda

Lwala Community Alliance ( email )

Rongo
Kenya

Diego Lassala

Muso ( email )

Bamako
Mali

Daniel Palazuelos

Harvard University - Brigham and Women's Hospital ( email )

75 Francis St.
Boston, MA 02115
United States

Carey Westgate

Community Health Impact Coalition ( email )

NY
United States

Fabien Munyaneza

Abwenzi Pa Za Umoyo - Partners In Health ( email )

Lilongwe
Malawi

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