Abstract
Community Health Workers are globally recognised as crucial members of healthcare systems in low and middle-income countries, but their role and experience during COVID-19 is not well-understood. This study aimed to explore factors that influence CHWs' ability and willingness to work in the COVID-19 pandemic in Lagos. A generic qualitative study exploring Community Health Workers experiences and perceptions of working during the COVID-19 pandemic in Lagos, Nigeria. 15 semi-structured, in-depth, video interviews were conducted with Community Health Workers purposively sampled across seven of Lagos' Local Government Areas with the highest COVID-19 burden. Interviews explored Community Health Workers' attitudes towards COVID-19, its management, and their experiences working in Lagos. Data was analysed thematically using the framework method. Three main themes were identified. 1. Influences on ability to undertake COVID-19 Role: Trust and COVID-19 knowledge were found to aid Community Health Workers in their work. However, challenges included exhaustion due to an increased workload, public misconceptions about COVID-19, stigmatisation of COVID-19 patients, delayed access to care and lack of transportation. 2. Influences on willingness to work in COVID-19 Role: Community Health Workers' perceptions of COVID-19, attitudes towards responsibility for COVID-19 risk at work, commitment and faith appeared to increase willingness to work. 3. Suggested Improvements: Financial incentives, provision of adequate personal protective equipment, transportation, and increasing staff numbers were seen as potential strategies to address many of the challenges faced. Despite Community Health Workers being committed to their role, they have faced many challenges during the COVID-19 pandemic in Nigeria. Changes to their working environment may make their role during disease outbreaks more fulfilling and sustainable. International input is required to enhance Nigeria's policies and infrastructure to better support Community Health Workers during both current and future outbreaks.
Highlights
On 30th January 2020, Coronavirus Disease-19 (COVID-19) was declared an international emergency [1]
Despite Community Health Workers being committed to their role, they have faced many challenges during the COVID-19 pandemic in Nigeria
This study aimed to explore factors that influence Community Health Workers (CHWs)’ ability and willingness to work in the COVID-19 pandemic in Lagos, Nigeria, and to identify how to better support CHWs during disease outbreaks
Summary
On 30th January 2020, Coronavirus Disease-19 (COVID-19) was declared an international emergency [1]. Community health extension workers (CHEWs) receive two to three years of “health-related training”, approved by the Community Health Practitioners Registration Board of Nigeria [7] This includes over 90 hours of lectures and “competency-based training” which gives them the skills to provide basic primary care as recognised by Nigeria’s national policy [7]. CHWs’ contribution to healthcare, within low and middle-income countries (LMICs), has been globally recognised [9–12] They provide care such as antenatal services, HIV and TB management, maternal, neonatal and child services and routine immunisation [9,13]. Community Health Workers are globally recognised as crucial members of healthcare systems in low and middle-income countries, but their role and experience during COVID-19 is not well-understood. This study aimed to explore factors that influence CHWs’ ability and willingness to work in the COVID-19 pandemic in Lagos
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