"…considered 'essential workers', so we report to work and serve the community": experiences of community health workers during COVID-19 pandemic in the Eastern Cape, South Africa.

backgroundCommunity health workers (CHWs) played an essential part in providing health services to the communities they served prior to and during the COVID-19 pandemic, and they had some positive impact on community/household health service promotion and delivery. Nonetheless, restricted movement and social isolation made it challenging for community members to access CHW services, which are normally provided in person. We explore community health workers' opinions on the impact of COVID-19 on their responsibilities, clients, and communities in South Africa's Eastern Cape.

methodsUsing a semi-structured interview guide, we conducted individual (n = 10) and focus group discussions (n = 13) with 23 community health workers. Participants were community health workers servicing three Black township communities in Buffalo Municipality District, Eastern Cape, South Africa. Transcripts from audiotaped and transcribed verbatim interviews were analysed thematically using Atlas.ti.

resultsThe COVID-19 had an impact on the CHWs' job-related activities, the clients' health, and caused disruptions in community social and economic activities, all of these had a negative impact on population health. COVID-19 had detrimental effects on the clients' health in various ways, including restricted movement and fear of contracting the virus, isolation and deaths created anxiety and terror, or refusal to attend clinics for routine medical check-ups and treatment. Furthermore, CHWs claimed that COVID-19 affected community livelihoods, exacerbating food insecurity and job insecurity. The vast majority of CHWs, who were predominantly women, had to balance their employment workload tasks with domestic responsibilities, which added extra pressure and burden. In addition, many individuals experienced personal loss and bereavement. However, the clients and the community exhibited remarkable resilience and perseverance despite the multifaceted obstacles faced by the COVID-19 pandemic.

conclusionFinancial hardships, unemployment, and work disruptions or changes created by the COVID-19 pandemic triggered stress, sadness, worry, and terror among the CHWs. The client's health conditions were adversely affected, as some clients refrained from visiting clinics for their medications and treatment because of restricted movements, concerns about contracting the virus, and isolation, all of which contributed to their anxiety and fear. The social isolation and quarantine, as well as food and job insecurity, all had an impact on the community's social and economic life. Despite the COVID-19 risks and stressors, CHWs demonstrated resilience during the COVID-19 pandemic burden and emphasising their importance as "essential workers" in community health care which further underscores the need to provide CHWs with adequate resources and training in preparation for future pandemics.