During emergencies, community health workers (CHWs) experience role-shift as situation-specific priorities modify responsibilities from pre-emergency work (health promotion, immunizations, etc.) to emergency specific tasks. CHWs experience psychosocial impacts of emergencies including burnout and PTSD impacting their ability to engage and sustain relief efforts, a well-described phenomenon for other first-responders. In epidemics, CHWs are stigmatized due to real or perceived proximity to affected individuals which also impacts credibility, social support, and motivation to participate in relief efforts. Health-system factors may mitigate the effects of perceived stigma and mental health through supportive governance, adequate training, and funding.
In 2023-2023 as a GloCal Fogarty Fellow, I developed and performed a study amongs CHWs in communities in the district of Piura, Peru impacted by both severe community wide flooding and the COVID-19 pandemic to determine factors that influence and sustain successful CHW response (e.g., mental health, stigma), and identify vulnerabilities within the current Peruvian CHW pandemic response. Our quantitative and qualitative data has provided the exceptional opportunity to explore unexpected sources of community resilience as well as identifying potential structural barriers to CHW emergency response. Given our recent completion of these findings, the proposed trip would involve my return to Peru in January 2025 to organize and facilitate a stakeholder meeting to disseminate findings and discuss potential interventions to improve CHW ability to respond to future emergencies.
This project will provide the opportunity for around 50 participants including ministry of health officials, physicians, nurses, community health workers and local NGOs to discuss opportunities to improve CHW integration into disaster response planning within the district of Piura. We anticipate keeping the meeting to this size to enable each key stakeholder to participate in shaping an intervention which could later be implemented and studied through outside funding. Regardless of any future investigation, the opportunity to discuss and collaborate with our findings will share findings from over 7 districts and more than 20 villages. We will further enable health facilities and ministry of health teams across these communities to identify and independently improve relationships and training of CHWs to strengthen system-wide resilience to climate and infectious disease emergencies.
We are certain this meeting will echo the voices of our 152 study participants across more than 20 villages, and we anticipate that the findings from this work will ultimately benefit the 2,103,099 individuals who live within the district of Piura, Peru.
We expect the outcomes of this stakeholder meeting to include the following:
- Interdisciplinary and cross-organizational conversation on the barriers experienced by CHW emergency responders identified by the study
- Identification of multiple structural factors that contribute to these barriers, and how these factors influence the real-time decision and ability of CHWs to respond to emergencies.
- Determining multiple realistic and culturally/structurally acceptable areas for intervention that could be targeted by community partners to improve emergency response in the community.
- Ultimately we hope that this meeting fosters continued community based academic partnerships to strengthen community health worker emergency response, which can be used as a resource for community health worker networks across the globe as we experience increased frequency of climate related emergencies.
Our trip to Piura, Peru, provided an opportunity to share our study’s findings with emergency response authorities, including the local director of the Ministry of Health, leaders of community health worker groups, and municipal officials. We began by presenting our findings to encourage discussion on the successes and challenges faced by community health workers in responding to emergencies such as flooding and the pandemic.
We highlighted how our work relates to global initiatives and shared compelling stories of community health workers overcoming severe flooding, family losses, and economic instability to identify and support neighbors in need. Additionally, we led two dynamic exercises to explore how the Ministry of Health and local government currently facilitate the activation of community health workers during emergencies.
Through multiple discussions, we examined ways the municipality and Ministry of Health can improve outreach to community health workers in crisis situations. We also explored strategies to strengthen training programs, ensuring health workers are well-prepared to respond effectively to future emergencies.
At the conclusion of our meeting, community health workers, municipal leaders, and Ministry of Health officials reaffirmed their commitment to collaborating on refining training programs to enhance emergency response efforts.
