One Year with COVID-19: A look at community health 

On March 11, one year will have passed since the World Health Organization (WHO) declared COVID-19 a global pandemic. In that time, we’ve seen some health needs change while others have grown more urgent or remained the same. One constant: the need for strong community health systems.

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A decline in facility-based care:

• Ninety percent of countries have experienced disruption to essential health services—including maternal and child health, HIV, family planning, and nutrition services—with low- and middle-income countries reporting the greatest difficulties. 

• An analysis by the WHO of five key essential health service indicators that include outpatient consultation, inpatient admission, and skilled birth attendance in 14 countries found a decline in these services between January and September 2020.

• A recent review of government data in Kenya and Uganda revealed declines of up to 35 percent in the number of people who sought facility-based care and treatments for common childhood diseases such as malaria, diarrhea, and pneumonia because of fears or lockdowns associated with COVID-19.

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An increase in demand for community-based care:

• Families increasingly turned to community health workers (CHWs) for health care during the crisis. From 2019 to 2020, the number of treatments and referrals Living Goods-supported CHWs provided to children under 5 per month spiked 84 percent in Kenya and 90 percent in Uganda. 

• The Africa Centres for Disease Control and Prevention is planning to recruit 1 million community health volunteers to support contact tracing across sub-Saharan Africa.

• Now is the time to invest in community health systems in sub-Saharan Africa and avert a greater crisis.

• From 2015 to 2020, data shows that 1,198 dispensaries, 884 health centers, 71 district hospitals, 10 regional hospitals, and 5 zonal referral hospitals have been built in Tanzania. However, there is still the need to recruit and improve the knowledge of CHWs to support this progress.

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An urgent need to protect frontline health workers: 

• At least 44,000 health workers in Africa have been infected with COVID-19, threatening their lives and overall health system capacity.

• In September 2020, one in seven reported cases of COVID-19 were health workers and at least 7,000 had died.

• Frontline health workers are the heart of health systems and many lack the personal protective equipment and other support they need to keep themselves and their patients safe. 

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Healthcare worker shortages continue to be a problem:

• There is an estimated shortage of 18 million health workers worldwide. In many contexts, whether during crises or routine decision-making, planners and policymakers are unaware of how many health workers are actually available and ready to address community challenges. 

• Adding to this pandemic is the significant shortage of key frontline health workers in Tanzania (merely 5.2 clinical health workers per 10,000 people) despite widespread unemployment among doctors and nurses in the country. 

• Nigeria has one of the largest stocks of human resources for health (HRH) in Africa but, like the other 57 HRH crisis countries, has proportions of nurses, midwives, and doctors that are still too low to effectively deliver essential health services (1.95 per 1,000 people).

• Despite the efforts made in the past two decades to increase the number and skill mix of health work forces, Ethiopia still has a low health workforce (medical doctors, health officers, nurses and midwives) proportions  (0.96/1,000 people. This means, with the rising population, the country needs to produce over 30,000 health workers  every year for the next 12 years to achieve UHC by 2030.

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