In an American hospital, a physician raises her head to hear yet another set of sirens arriving at the hospital—the third one in just the last hour. Frequent and unnecessary emergency visits have overburdened this ER and ERs nationwide—a problem further exacerbated during the COVID-19 pandemic. 9,000 miles away, a community health worker (CHW) in Uganda gears up with PPE to prepare for her daily visits with her Malaria and COVID patients. CHW programs like hers across the continent mitigate and treat specific health problems within the community—an aspect of healthcare crucial to effective pandemic response. The scenarios contrast the attitude and approach taken by the two healthcare systems. Although circumstances and policies differ significantly between the systems, the United States could learn a crucial lesson from the integrated and personalized care provided by CHWs.
CHWs are defined by the World Health Organization (WHO) as “health care providers who live in the community they serve and receive lower levels of formal education and training." Although more inexperienced than nurses or doctors, CHWs fill a crucial personal and present gap in many African communities, representing a culturally appropriate remedy to the remote, marginalized, and specialized needs of many communities. This workforce of over one million in Sub-Saharan Africa alone brings the services of primary health care to the individual, treating common ailments such as malaria, HIV, and more recently, COVID-19, as well as managing immunizations and maternal care. The exemplary action and impact of a workforce prepared to handle patient-to-patient cases on Africa’s response to the pandemic cannot be overstated.
Coming full circle, the American healthcare system would do well learning from CHW programs, especially in combating rising ER overuse. One currently proposed system that implements such personalized care is community paramedicine (CP) programs. Currently, many of these programs are specialized for recently discharged patients, actively promoting preventive measures through door-to-door visits and personal monitoring to lower remission rates and keep patients out of the ER. However, given adequate policy and attitude changes within America, many of these programs could be specialized just like CHWs and further reduce ER and general hospital strain for the plethora of problems America faces today. All in all, CP programs, and correlatively, CHWs offer a peek into a more intimate form of healthcare the future may behold.