Previously submitted to: Journal of Medical Internet Research (no longer under consideration since May 05, 2022)
Date Submitted: Oct 16, 2021
Open Peer Review Period: Oct 16, 2021 - Dec 11, 2021
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Using telehealth to support 3500 community health workers in rural Uganda: much-needed support during an elusive pandemic
ABSTRACT
Background:
At the beginning of the COVID-19 pandemic, many low-income countries were confronted with a difficult challenge: with little resources and while implementing a stringent lockdown, they had to rapidly train thousands of Community Health Workers (CHW) in rural and remote areas about the new virus and then find a way to continue to support them in providing health services and products. Shortly after the first COVID-19 case was confirmed in Uganda, a local consortium developed a telehealth approach that aimed to inform 3500 CHWs about COVID-19, support them in identifying, referring and caring for possible COVID-19 cases and help them to continue to provide basic health services and products.
Objective:
To assess the functioning of the telehealth approach that was set up to support community health workers in rural communities in Uganda with sustaining basic health services and dealing with the COVID-19 pandemic.
Methods:
For this mixed-method study, we combined analysis of 1) consultation data from the call-center that supported a network of 3500 CHW in 23 districts in rural Uganda, 2) 24 in-depth interviews with purposively selected CHWs and health professionals working at the call center, and 3) two surveys of 150 active CHWs
Results:
Between March 2020 and June 2021, a total of 35,553 consultations took place via the call center. While the CHWs made extensive use of the call center, they rarely asked for support for potential Covid-19 cases. The CHWs said there were no signs that people in their communities were suffering from severe health problems due to COVID-19. Because COVID-19 appeared to cause no visible health problems, many people were skeptical about the danger of COVID-19. At the same time, people in rural areas were afraid to report relevant symptoms and get tested for fear of being quarantined and stigmatized. The telehealth approach did prove useful in supporting CHWs in providing regular health services and products in rural communities. The health professionals at the call center supported CHWs in diagnosing, referring and treating patients, adhering to infection prevention and control practices, and communicating product needs. The CHWs felt more informed and less isolated and said the support helped them provide better care and improve the delivery of essential health products.
Conclusions:
The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. The telehealth approach could be quickly set up and scaled up and offers a low cost strategy for providing useful and flexible support to CHWs in rural communities. Clinical Trial: Not applicable
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