COVID-19 is an unprecedented pandemic which has led to millions being affected and thousands dying every day across the world.  The Government of India has announced a 21-day lockdown to prevent COVID-19 transmission in India -essentially buying time for health systems to be better prepared. While tertiary care systems are also being prepared it is important to ensure preparedness of Primary Health Centres.

Towards this mammoth effort, the Indian medical and public health community is contributing in a big way. To ensure preparedness of Primary Health Centres in rural/community settings, 15 clinicians and public health experts from leading institutions, including The George Institute for Global Health, India formed the COVID-19 PHC Action Group. The COVID-19 PHC Action group,  a collaborative is led by Dr Prashanth NS, Institute of Public Health, Bangalore. Dr Soumyadeep Bhaumik from The George Institute for Global Health has contributed majorly to development of the policy resource.

The initial public version was released on 27th March 2020. The current and final version has been disseminated and shared with multiple state governments and other stakeholders.

COVID-19 is a respiratory illness caused by a newly discovered coronavirus was first reported in Wuhan, China in December 2019. Subsequently it has spread to 187 countries and territories with more than 294,110 cases and 12,944 deaths globally.

Countries across the world are introducing measures to prevent its spread, increasing capacity for quarantine and building capacity of hospitals (particularly intensive care units) to manage positive cases. With efforts to prevent community transmission of COVID-19 being a top priority, ensuring preparedness of frontline health workers (FLHWs) is essential.

The Government of India is embarking on a mammoth task to prevent COVID-19 spread among communities. The Rapid Evidence Synthesis team received a request to support the planning and development of resources for ensuring preparedness of FLHWs for COVID-19 . The rapid evidence synthesis was conducted in a period of three days.

The findings highlight what we can learn from recent pandemics such that we are prepared for potential scenarios and challenges due to COVID-19. Key issues which decision-makers need to consider, based on available evidence are:

1. FLHWs will be at an increased risk of COVID-19, even in the course of their normal activities. It is essential to provide personal protective equipment (gloves, surgical masks, hand sanitisers; N95 masks if involved in contact tracing) in adequate quantity. This should be accompanied by training on proper usage in the early phase itself.
2. Disruption in supply-chain, logistics and supportive supervision might be expected and this would impact routine service delivery. Advice should be given on which activities are to continue and which might be postponed. Guidelines and protocols for conducting additional activities and training is required.
3. Engaging FLHWs who continue to perform routine service delivery in additional contact identification and listing, is not without its risk including that of transmission of COVID-19. A role focussed on creating awareness and support for prevention and countering social stigma is recommended for FLHWs.
4. FLHWs might experience stigmatisation, isolation and been socially ostracised. Providing psychosocial support, non-performance-based incentives, additional transport allowance, child-care support should be planned. Awards and recognition are required for motivation.
5. Social distancing related measures might not be appropriate in many contexts like urban slums, large/joint families, those living in small houses and the homeless.

The rapid evidence synthesis goes beyond research evidence and integrates multiple types and levels of evidence from across the world. The inventories provided serve as a ready resource guide for any country considering the use of FLHWs to control COVID-19.

The full rapid evidence synthesis and supporting appendices are available below

Download full report (PDF 319 KB)

• Download Appendices for Frontline health workers in COVID-19 prevention and control: rapid evidence synthesis (PDF 381 KB)

• Download COVID-19 myths and facts poster (PDF 607 KB)

• Download Recommendations on the role of CHWs in the COVID-19 response poster (PDF 1.6 MB)

• Download Community health workers for pandemic response: rapid evidence synthesis (PDF 473 KB)

This report is a part of the “Ensuring Health Systems Capacity for COVID-19 and Beyond: Evidence Series”.
The series aims to provide high quality and contextualised evidence from systematic reviews or rapid evidence synthesis to work on the opportunity the COVID-19 scenario offers i.e., to build a strong, resilient and equitable health system in India and other low and middle income countries.

External Resources

Community health workers for pandemic response: a rapid evidence synthesis - an article published in BMJ Global Health

SMARThealth is a mobile device-based clinical decision support system developed by The George Institute for Global Health that allows community health workers to assess cardiovascular (CVD) risk using basic equipment and refer those at high risk to nurses or physicians for further consultation.

CVD is estimated to be the cause of one third of all deaths in Indonesia in 2016, but current data suggests that less than one third of those with moderate to high risk of CVD receive any preventive care.

A recent study involving rural villagers in Malang, Indonesia, who were identified as being at high risk of cardiovascular disease, was set up to evaluate how effective SMARThealth could be when used within a complex local health system.

SMARThealth resulted in a significant increase in the use of optimal combinations of preventive medications (a blood pressure lowering drug together with a statin and aspirin in those with previous CVD) among highrisk people. In particular, SMARThealth resulted in large increases in the use of blood pressure lowering drugs in the intervention villages compared to the control villages reductions in blood pressure. Following the success of this study, the Malang district government is now aiming to scale-up SMARThealth to around 400 villages over the next three years.

A consortium of researchers including the George Institute for Global Health, the University of Brawijaya and the University of Manchester have been funded by the Australian National Health and Medical Research Council to provide technical assistance for, and to evaluate, this scale-up.

The Malang study was funded by Give2Asia on the recommendation of The Pfizer Foundation and NHMRC program grant APP1052555. The Pfizer Foundation is a charitable organisation established by Pfizer Inc. It is a separate legal entity from Pfizer Inc. with distinct legal restrictions.

Read more about this research here.

More about SMARThealth impact here.