A community health worker from another village fills out her register after seeing a malnourished child and his mother.

Rapid evidence summary: Community health workers during infectious disease outbreaks

What can we learn from community-based healthcare service delivery during previous outbreaks?

In many parts of the world, community health workers play a critical role in meeting the needs of their communities, particularly where formal health facilities are inaccessible. Our rapid evidence review looked at the role of community health workers in infectious disease outbreaks around the world. The majority of literature emerged from the Ebola outbreak in West Africa, including Guinea, Liberia, Sierra Leone, and Ivory Coast.

The literature shows that community health workers played a key role during the Ebola outbreak, especially for combatting the outbreak itself. And although service delivery was undoubtedly affected by the outbreak, community health workers were also often able to continue delivering other critical services to their communities. These services included integrated community case management, and maternal, newborn and child health. Sometimes these services were provided at higher levels than before the outbreak.

One study conducted in Guinea, Liberia, and Sierra Leone found a sharp decline in maternal, newborn and child health service provision in the early months of the Ebola outbreak due to weak service delivery, confusion over policy, and the overwhelming nature of the disease. Even so, community health workers remained active in their communities and were willing to continue providing services. Once they received clear directives to restart case management services, additional training, and necessary supplies, service delivery rebounded despite the outbreak.

Community health workers also played an integral role in building community resilience. In humanitarian contexts, resilience is the ability of healthcare workers and governments to effectively prepare for and respond to crises. Multiple studies investigated the role of community health workers as essential components of resilient healthcare systems. One study found that they served as trusted sources of advice and treatment in three Liberian communities where there was significant distrust of health facilities. Consultation between health facility personnel and community health workers before the outbreak was key in reducing this level of distrust and building resilience, as it supported more effective risk communication and community action.

There are limitations to the empirical studies in this summary: they are all retrospective and observational; some suffer from potential bias and all suffer from incomplete data. Given the nature of epidemics, it is difficult to obtain rigorous assessments of impact. However, the peer-reviewed perspective pieces clearly outline the roles that community health workers can play during epidemics. Overall, there is promising evidence.

Read the full rapid evidence review for more details on the reviews, recommendations, and links to studies.

Stay tuned for more evidence reviews on a variety of interventions here.