Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh: A Mixed Methods Study

Government-employed community health workers in Bangladesh are essential actors in the COVID-19 response in communities. Ensuring the workers’ equitable access to supportive mechanisms for their work, including training, infection prevention supplies, and supportive supervision, is critical for successfully preventing and managing COVID-19 in Bangladesh. Key Findings During the first wave of the coronavirus disease (COVID-19) pandemic in Bangladesh, across all health areas, community health workers (CHWs) described a slight decrease in the routine services they were able to provide due to restrictions in movement posed by lockdowns and other challenges. The government and various nongovernmental organizations provided supportive mechanisms to CHWs through training, supplies, and supportive supervision; however, these supports were not always uniformly distributed across cadres, leading to some discontent among CHWs. CHWs were crucial actors in the government’s COVID-19 response, as they took on new pandemic-related responsibilities in their communities to prevent the spread of the disease while continuing their routine work. Key Implications Government actors such as policy makers and nongovernmental actors involved in the community COVID-19 response in Bangladesh should consider CHW perspectives on supportive mechanisms and include them in future pandemic programming. National stakeholders can strive to ensure equitable support, incentives, and supervision to family welfare assistants and health assistants working across all health areas as they undertake new COVID-19 responsibilities in their communities. ABSTRACT Introduction: Understanding community health workers’ (CHWs) experiences of sustaining routine health care promotion and provision activities as well as their challenges in adopting new responsibilities within a dynamic context is critical. This study explored the roles and perspectives of CHWs within the government-led coronavirus disease (COVID-19) community health response in Bangladesh. Methods: We conducted a mixed methods study to explore the government’s response to COVID-19 and its association with community health programming through a telephone-based survey of 370 government-employed CHWs. We also conducted 28 in-depth interviews with policy makers, program managers, CHW supervisors, and CHWs. We conducted exploratory and regression analysis of survey data and qualitative analysis of interview data. Results: The majority of CHWs reported receiving training related to COVID-19, including community-based prevention strategies from government and nongovernment stakeholders. Access to infection prevention supplies differed significantly by CHW cadre, and perspectives on the provision of adequate supplies varied qualitatively. CHWs reported slight decreases in routine work across all health areas early in the pandemic, and a majority reported added COVID-19-related responsibilities as the pandemic continued, including advising on signs/symptoms in their communities and referring suspected cases of COVID-19 for advanced facility care. Regression analyses showed that government support and integration of CHWs into their response—particularly being trained on COVID-19—predicted CHW capacity to advise communities on symptoms and provide routine services. Discussion: Government-employed CHWs in Bangladesh continued to provide health education and routine services in their communities despite pandemic- and response-related challenges. Varied support and differential CHW cadre-specific effects on COVID-19 awareness building in the community, referral, and routine service provision merit attention in Bangladesh’s pluralistic community health system. While COVID-19 infection and government-mandated lockdowns restricted CHW mobility, the workers’ capacity to continue service provision and education can be leveraged in vaccination and surveillance efforts moving forward.