As the world races to halt the spread and impact of COVID-19, gaps in health systems are coming into stark relief. Particularly vulnerable are those in underserved and low-resource communities, across low- medium- and high-income countries alike, who experience fragmented access to health care. These patients — especially those with chronic conditions — are at significant risk, as are the frontline health workers caring for them.
The World Health Organization has identified community health workers, or CHWs, as a key resource to providing basic health services for underserved areas, as well as health education.
Randomized trials have shown that compassionate care leads to better patient outcomes. Empathy and supportive care have been shown to reduce healing times, length of stay in hospitals, emergency department visits, and mortality. At a time when all systems are, or will be, more strained than they ever have been before, these outcomes are critical to sustain.
No longer can we afford to view the world from silos or line items. We must view it from the perspectives of patients, of communities, and the health workers that link them to affordable, quality care.
—We at Medtronic Foundation know about the transformational power of investing in health workers — from CHWs and paramedics to frontline nurses and physicians — from our long-standing history strengthening acute and chronic diabetes and cardiovascular care in low-resource settings.
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Trained and supported health workers are extensions of both their communities and the health systems. More than 70% of these health workers are women, a much larger share of the workforce than other sectors. They are well-positioned to deliver patient-centered, personalized, and efficient care for the underserved, improving health outcomes, and economic development of their communities.
Often, they are delivering care directly in homes, or through community settings such as microfinance groups. They support patients to navigate barriers to care including but beyond pharmacotherapies, including transportation, food security, and lifestyle modifications. They are often equipped with digital information and tools such as mobile electrocardiogram. These models may be more relevant than ever as COVID-19 will force us to innovate and extend services beyond clinical walls.
CHWs have a critical role to play in the prevention, detection, and response to COVID-19. To do so, they must be well trained, supervised, equipped, protected, and compensated. For example, they can ensure their patients and community members practice critical behaviors to prevent infection, including hand-washing and social distancing, even in places where social distancing and isolation requires local innovation, such as urban slums.
As testing becomes more rapid and decentralized, they can play a critical role in reaching vulnerable and underserved populations in the hardest to reach settings. We know the power of CHWs, not as free labor, but as an integrated part of care teams, because we’ve seen it through our partnerships.
In South Africa, Medtronic Foundation partners have supported CHWs, equipping them with skills, and tools — such as digital blood pressure machines and glucometers — to use during their in-home visits and community settings.
In India, CHWs keep connected to their patients through text messages to help meet their health goals, and support surveillance of patients’ risk of chronic disease through a health card, now fully sustained and managed by the local government. And in Brazil, community health agents support underserved patients with diabetes and hypertension by leading peer groups that helped improve self-care and health literacy, with an emphasis on healthy nutrition and habits, while also ensuring linkages to routine clinical visits.
On average, more than 55% of patients enrolled in these programs with regular hypertension and diabetes readings achieved clinical control, significantly reducing their risk of catastrophic cardiovascular complications and hospitalization. Many of these patients are now isolating at home, with ongoing support from CHWs.
In rural Minnesota, United States, we’ve also built a multi-year partnership with a community clinic called HealthFinders. HealthFinders serves refugees, immigrants, and patients living below the poverty line.
When one patient with diabetes missed her regular appointment, Bisharo Farah, a HealthFinders CHW, reached out to check on her progress. On a subsequent home visit, Farah found the patient wasn’t taking her medication, testing her blood sugar, or exercising. As an immigrant who was still learning English and couldn’t read or write, she had become isolated in the community.
Farah worked with her to set realistic goals to improve her diet, reminded her how to check her blood sugar level routinely, and helped her to meet several of her neighbors so she could build stronger social connections. Over time, her blood sugar stabilized, and her well-being did too. Through the Minnesota state COVID-19 lockdown, Farah has continued to check on her and many other chronic patients, through calls, YouTube videos, and video consultations.
The debate is no longer about communicable versus noncommunicable diseases.
—Looking to the future
Building on these successes, we plan to expand our focus on supporting CHWs in underserved places around the world. Through HealthFinders, we’re equipping CHWs with the skills they need to refer and track patient improvement through digital information systems.
We’re also working with them to strengthen care coordination, as well as care for service continuity for chronic patients during the COVID-19 outbreak. This also applies to areas hard-hit by natural disasters such as Puerto Rico and Sonoma County, California. There, CHWs are providing home and center-based care for chronic care management, supporting disaster preparedness, and promoting resiliency strategies for the underserved.
Just as we cannot lose sight of the underserved chronic patients, we also cannot lose sight of all frontline health workers. If we want to grow and scale the gains we’ve seen in underserved settings, we must ensure health workers are operating in safe conditions, with access to personal protective equipment and efficient workforce planning for surge capacity to meet greater demand for services.
We’ve committed $10 million to COVID-19 response efforts, a significant share of which is dedicated to supporting and equipping frontline health workers, as well as investing in locally responsive efforts that assist vulnerable populations. Finally, we are also enabling virtual volunteer opportunities for Medtronic employees and doubling our match of their charitable giving to nonprofit organizations in need.
As those working in health and development know, the debate is no longer about communicable versus noncommunicable diseases; nor about prevention versus treatment, primary care versus tertiary care. No longer can we afford to view the world from silos or line items. We must view it from the perspectives of patients, of communities, and the health workers that link them to affordable, quality care.
It’s our goal to empower more CHWs like Farah, who can simplify the health system and personalize care for those most in need, and can humanize the care experience, at a time when our global vulnerability and our humanity is on display.
To learn more about the impact community health workers can make for underserved patients around the world, click here.
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