Almost all African states have reported cases of the new coronavirus disease (COVID-19). To include the disease, they cannot rely just on doctors and nurses, that are in short supply and at high risk of disease in the workplace.

The World Health Organisation (WHO) recommends that every nation should have a minimal of 445 health workers — such as physicians, nurses, and midwives — for each 100,000 people. But in sub-Saharan Africa, the ratio of healthcare workers to the population is very low: 46 from 47 nations have less than this amount, though it does change.

Considering that the 1970s, African American nations have utilized public health employees to handle gaps in the health workforce. All these are neighborhood volunteers trained to provide basic health services.

Their function is important because they can be trained to recognize symptoms, diagnose specific ailments, and even dispense drugs. Additionally, since they’re long-time residents in their communities, they are known and trusted sources of advice.

To help cope with the COVID-19 pandemic, some countries like Kenya and South Africa have mobilized community health workers. In Liberia they are helping implement prevention and control steps.

But neighborhood health workers still face many challenges. As an example, they’re usually not compensated enough for the work they do and are not given proper direction or instruction.

It’s significant that these struggles are addressed so that they can be effective — and better encouraged — when they carry out their work.


The WHO has created a number of standards for successful community health programs in the COVID-19 response. The advice will be to include them at all levels — in crisis response forums, equip them with essential knowledge and skills, describe their roles and duties, and provide them with essential tools to protect themselves from COVID-19 and block the spread of the virus.

But previous research indicates that these boxes might not always be ticked.

A study into the effectiveness of public health employees throughout the 2014-2016 West Africa Ebola epidemic decided that the maintenance of healthcare services along with the Ebola response were hampered because community members were engaged late in the reaction.

A reason for this is that community health workers are poorly integrated into existing health systems. Countries didn’t build the direction and training structure required for successful integration. A research in South Africa about the government of community health worker programs revealed that this creates fragmentation in healthcare delivery and the community health workers do not contribute to significant decisions.


Another big concern is that community health workers do not get enough support or aren’t well protected.

This was emphasized in the Ebola study. From the three Ebola-affected countries they obtained very compact travel allowances. Without reimbursement workers couldn’t consistently make themselves accessible to their voluntary actions because of other commitments that brought them an income. Additionally, it meant they couldn’t be held accountable for their responsibilities as they weren’t being compensated.

This is a frequent challenge. A recent study on HIV service delivery in low income nations found that, although community health workers conduct emotionally and physically demanding tasks, their prices aren’t covered. For instance, they’d have to pay their own transport fees to perform work. This has an impact on the care they can provide and can also lead to them feeling disempowered.

The analysis also discovered that they often don’t have adequate training and oversight. Many community health workers have had their responsibilities poorly clarified to them, causing some to assume jobs which otherwise belong to higher paid and trained employees.

A lack of support and supervision may also be found everywhere. A study in Kenya saw that in some situations, community health workers have been spoken about or spoken for, but receive little support in practice.

Moving Ahead

Government should consider setting a minimum standard of reimbursement and community health workers and local authorities should openly talk about the burdens that workers may face and the need for alternatives to overcome them. For instance, if community health workers have to travel long distances, resources such as bikes should be set into program budgets.

This may tap into their expertise and make the goals more achievable in practice.