The COVID-19 pandemic has exposed the vulnerabilities of healthcare systems worldwide, particularly in the Caribbean region. It has highlighted the need for a more resilient and responsive approach to public health, one that prioritizes primary healthcare and health prevention. As countries in the Caribbean seek to build back better, reinvesting in community health workers (CHWs) presents a vital strategy for strengthening healthcare systems and improving health outcomes.

Community health workers (CHWs) often live in the community they serve and may often receive lower levels of formal education and training than professional health care workers such as nurses and doctors. According to the World Health Organization (WHO, 2021), This human resource group has enormous potential to expand the reach of the public health system especially benefitting vulnerable populations such as rural, remote, or hard-to-reach communities and marginalized people. CHWs are often impacted by the said challenges themselves and know the language, culture, and dynamics of the communities they engage which improves the performance, efficacy, and efficiency of the health system. In the Caribbean, CHWs have played a crucial role in improving access to healthcare, particularly in rural and underserved areas (Jeet et al., 2017)

At Uwàmìto Consulting, we have witnessed firsthand the impact of investing in CHWs. Through our technical assistance and capacity-building efforts, we have supported clients in Trinidad and Tobago and Suriname to strengthen their CHW programs. In Trinidad and Tobago, we engaged stakeholders, conducted community pilots, and trained individuals to implement Risk Communication and Community Engagement (RCCE) methodologies, reaching over 2,000 people with health services. In Suriname, we provided technical assistance to develop and implement a Community-Led Monitoring (CLM) system to improve the quality and accessibility of HIV services.

The evidence supporting the effectiveness of CHWs in improving health outcomes is compelling. A systematic review by Scott et al. (2018) found that CHW interventions led to significant improvements in maternal and child health, infectious diseases, and non-communicable diseases in low- and middle-income countries. Another study by Kangovi et al. (2020) found that a CHW program in the United States reduced hospital readmissions and improved patient satisfaction.

Investing in CHWs also makes economic sense. A study by Seidman and Atun (2017) estimated that scaling up CHW programs in sub-Saharan Africa could yield a return on investment of up to 10:1, with significant savings in healthcare costs and increased economic productivity. In the Caribbean, where many countries face resource constraints and increasing healthcare costs, investing in CHWs can be a cost-effective strategy for improving health outcomes.

To fully realize the potential of CHWs in strengthening Caribbean healthcare systems, there is a need for increased investment and policy support. This includes:

1. Providing comprehensive training and certification programs for CHWs, covering a wide range of healthcare topics and skills.

2. Integrating CHWs into the formal healthcare system, with clear roles and responsibilities, adequate compensation, and opportunities for career advancement.

3. Allocating sufficient resources for CHW programs, including funding for salaries, training, and equipment.

4. Developing partnerships between CHWs, healthcare facilities, and community organizations to improve coordination and referral systems.

5. Investing in research and evaluation to better understand the impact and effectiveness of CHW programs in the Caribbean context.

Countries in the Caribbean that already have CHW programs can benefit from a boost in investment and policy support. For countries without CHW programs, there is an opportunity to learn from the experiences of other countries and invest in this vital workforce. The COVID-19 pandemic has underscored the importance of building resilient and responsive healthcare systems, and CHWs are a critical part of the solution.

At Uwàmìto Consulting, we are committed to social development, and having a strong health system is a critical element for development in the Caribbean. Through the technical assistance, we continue to see the importance of primary health care, and more importantly, the role CHWs can play in strengthening the overall health system. We therefore call on all governments, key stakeholders, and development partners to prioritize investments in this important strategy to improve the resilience and sustainability needed to secure the future of the Caribbean.

References:

• Kangovi, S., Mitra, N., Norton, L., Harte, R., Zhao, X., Carter, T., Grande, D., and Long, J.A., 2020. Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: A randomized clinical trial. JAMA Internal Medicine, 180(10), pp.1315-1324.

• Kraef, C., Kallestrup, P., Olsen, M.H., and Bjerregaard, P., 2020. Community health workers in the era of COVID-19: A systematic review. Tropical Medicine & International Health, 25(11), pp.1327-1336.

• Scott, K., Beckham, S.W., Gross, M., Pariyo, G., Rao, K.D., Cometto, G., and Perry, H.B., 2018. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Human Resources for Health, 16(1), pp.1-17.

• Seidman, G., and Atun, R., 2017. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Human Resources for Health, 15(1), pp.1-13.

• Jeet, G., Thakur, J.S., Prinja, S. and Singh, M., 2017. Community health workers for non-communicable diseases prevention and control in developing countries: Evidence and implications. PLOS ONE, 12(7), p.e0180640. https://doi.org/10.1371/journal.pone.0180640