ABSTRACT

This paper aimed to systematize and analyze the literature that addresses the role of Community Health Workers (CHWs) in addressing the Covid-19 pandemic. This scoping review was conducted in the Embase, Lilacs, SciELO, Medline, and Cochrane Virtual Libraries databases. It includes publications from January to December 2020, and the selected studies were submitted to analysis, considering the following categories: practices, training, working conditions, and legitimacy. Twenty-nine studies were included in the review whose CHW performance backdrops were African, South American, North American, Asian, and European countries. The results revealed diversified approaches to practice in the countries studied that involve care, surveillance, health communication, education, administrative, intersectoral articula- tion, and social mobilization actions. The training received does not seem to correspond to the list of practices and expected impact of the CHWs. Working conditions remain substandard, with some extra incentives offered in different backdrops. The recognition and legitimacy before the health authorities reveal the dispute over the direction of health care models and the scope of social protection systems in different countries.

KEYWORDS
Community Health Workers; Coronavirus infections; Public health; Global health

Introduction

The International Labor Organization (ILO) defines Community Health Workers (CHWs) as professionals who provide health education and referrals to a wide range of services, providing support and assistance to communities, families, and individuals with preventive and access measures to adequate social and health services^{11 International Labour Office. International Standard Classification of Occupations 2008 (ISCO-08): structure, group definitions and correspondence tables. [Local desconhecido]: International Labour Office; 2012.}. Much evidence has shown positive results from the work they do in low-, middle- and high-income countries, besides the persisting gaps and barriers that must be overcome regarding the pathways of these workers in the different health systems<sup>22 Perry H. Health for the people: National community health worker programs from Afghanistan to Zimbabwe. Washington, DC: USAID; 2020.

3 Lu C, Palazuelos D, Luan Y, et al. Development assistance for community health workers in 114 low- and middle-income countries, 2007-2017. Bull World Health Organ. 2020 [acesso em 2021 fev 2]; 98(1):30-39. Disponível em: doi: 10.2471/BLT.19.235499.
https://doi.org/10.2471/BLT.19.235499... -44 Najafizada SA, Bourgeault IL, Labonte R, et al. Community health workers in Canada and other high-income countries: A scoping review and research gaps. Can J Public Health. 2015 [acesso em 2021 fev 2]; 106(3):e157-64. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26125243/
https://pubmed.ncbi.nlm.nih.gov/26125243...</sup> . Regarding action in response to health crisis contexts, the literature clarifies that they bring efficient and effective contributions, such as actions in the HIV, Dengue, Zika, and Ebola epidemics^{55 Silva NHLP, Cardoso CL. Agentes comunitários de saúde: sentidos acerca do trabalho em HIV/AIDS. Psicol. Soc. 2008 [acesso em 2021 fev 2]; 20(2):257-266. Disponível em: https://www.scielo.br/j/psoc/a/PtFfb38XDv7jnZThz3qgdDP/?lang=pt
https://www.scielo.br/j/psoc/a/PtFfb38XD... ,66 Boyce MR, Katz R. Community Health Workers and Pandemic Preparedness: Current and Prospective Roles. Front Public Health. 2019 [acesso em 2021 fev 2]; 7:62. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443984/
https://www.ncbi.nlm.nih.gov/pmc/article...} .

The International Health Regulations (2005), the Guidelines to Optimize CHW Programs (2018), and the Global Influenza Strategy for 2019-2030 (2019), published by the World Health Organization (WHO), are accumulations and guidelines for countries to improve prevent, protect, and control the international spread of diseases, considering the importance of the involvement of CHWs and communities<sup>77 World Health Organization. International health regulations (2005). [Local desconhecido]: World Health Organization; 2005.

8 World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. [Local desconhecido]: World Health Organization; 2018.-99 World Health Organization. Global influenza strategy 2019-2030. [Local desconhecido]: World Health Organization; 2019.</sup>.

In the Covid-19 pandemic, a critical health event, it is essential to place the organic body, the human subject, society, the environment, and culture at the center of the analysis. Thus, the importance of responses that involve both medications and hospital services and complex measures is revealed, and Primary Health Care (PHC) integrated with Epidemiological Surveillance holds a prominent place^{1010 Almeida Filho ND. Modelagem da pandemia Covid-19 como objeto complexo (notas samajianas). Estud. Av. 2020 [acesso em 2021 fev 2]; 34(99),97-118. Disponível em: https://www.scielo.br/j/ea/a/PYKMh83rMm77yFnjxCWzLMy/?lang=pt
https://www.scielo.br/j/ea/a/PYKMh83rMm7... ,1111 Giovanella L, Vega R, Tejerina-Silva H, et al. ¿Es la atención primaria de salud integral parte de la respuesta a la pandemia de Covid-19 en Latinoamérica? Trab. Educ. Saúde. 2021 [acesso em 2021 fev 2]; 19:e00310142. Disponível em: https://www.scielo.br/j/tes/a/CJX9Rs5gSBJmsMrfwhkdJrL/
https://www.scielo.br/j/tes/a/CJX9Rs5gSB...} . From this perspective, the CHWs are in a strategic position, reorienting practices to face and mitigate the pandemic effects.

This article aims to systematize and analyze the literature that addresses the work of CHWs in addressing the Covid-19 pandemic, considering recommendations, practices, training, working conditions, and legitimacy.

Material and methods

This Scoping Review employed the review method proposed by the Joana Briggs Institute (JBI). This method maps the main concepts, clarifies research and knowledge gaps, and synthesizes different types of studies on policies to improve health outcomes^{1212 Joanna Briggs Institute. Methodology for JBI Scoping Reviews - Joanna Briggs 2015. Australia: JBI; c2015. [acesso em 2021 jul 11]. Disponível em: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf
https://nursing.lsuhsc.edu/JBI/docs/Revi...} .

The Population, Concept, and Context (PCC)^{1212 Joanna Briggs Institute. Methodology for JBI Scoping Reviews - Joanna Briggs 2015. Australia: JBI; c2015. [acesso em 2021 jul 11]. Disponível em: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf
https://nursing.lsuhsc.edu/JBI/docs/Revi...} strategy was used to build the research question, as follows: P - CHW; C - Work; and C - Covid-19 pandemic. Based on these definitions, the guiding question of this review was defined: How did the CHWs work to face the Covid-19 pandemic, considering recommendations, practices, training, working conditions, and legitimacy?

An electronic search was carried out from February 1 to 20, 2021, in Bireme Virtual Libraries, to access Latin American and Caribbean Literature on Health Sciences (Lilacs) and Scientific Electronic Library Online (SciELO); PubMed, to access studies published in Medical Literature Analysis and Retrieval System Online (Medline); Cochrane Library/Cochrane Database of Systematic Reviews; and the Excerpta Medica Database (Embase).

In the search strategy, we employed the Portuguese Boolean descriptors and operators^{1313 Santos CM, Pimenta CA, Nobre MR. A estratégia PICO para construção da pergunta de pesquisa e busca de evidências. Rev Lat Am Enfermagem. 2007 [acesso em 2021 fev 2]; 15(3):508-11. Disponível em: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdfhttps://www.scielo.br/j/rlae/a/CfKNnz8mvSqVjZ37Z77pFsy/?lang=pt
https://nursing.lsuhsc.edu/JBI/docs/Revi...} “Agente Comunitário de Saúde” AND “Coronavirus Infections”, registered in the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH). Terms related to “Agente Comunitário de Saúde” were identified in the literature<sup>44 Najafizada SA, Bourgeault IL, Labonte R, et al. Community health workers in Canada and other high-income countries: A scoping review and research gaps. Can J Public Health. 2015 [acesso em 2021 fev 2]; 106(3):e157-64. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26125243/
https://pubmed.ncbi.nlm.nih.gov/26125243... ,1414 Queiros AALD. A prática dos agentes comunitários de saúde na América Latina: origem, contradições e desafios para o cuidado em saúde no começo do século XXI. [tese]. São Paulo: Universidade de São Paulo; 2015. 143 p.

15 Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014 [acesso em 2021 fev 2]; 35:399-421. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24387091/
https://pubmed.ncbi.nlm.nih.gov/24387091...

16 Mallari E, Lasco G, Sayman DJ, et al. Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines. BMC Health Serv Res. 2020 [acesso em 2021 fev 2]; 20(1):860. Disponível em: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05699-0
https://bmchealthservres.biomedcentral.c... -1717 Henderson S, Kendall E. ‘Community navigators’: making a difference by promoting health in culturally and linguistically diverse (CALD) communities in Logan, Queensland. Aust J Prim Health. 2011 [acesso em 2021 fev 2]; 17(4):347-54. Disponível em: https://www.publish.csiro.au/py/py11053
https://www.publish.csiro.au/py/py11053...</sup> , which were also searched using the Boolean operators AND and OR, one by one, as detailed in the example below. The following strategy was adopted on February 20, 2020, on Medline, through PubMed:

“Community Health Workers” AND “Coronavirus Infections”; “Frontline health workers” AND “Coronavirus Infections”; “Lay Health Workers” AND “Coronavirus Infections”; “Close-to-community providers” AND “Coronavirus Infections”; “Anganwadi Worker” OR “Accredited Social Health Activist” OR “Auxiliary Nurse Midwife” AND “Coronavirus Infections”; “Gizi” OR “Kesehatan” OR “KB” AND “Coronavirus Infections”; “Community Health Agent” AND “Coronavirus Infections”; “Family Welfare Assistant” AND “Coronavirus Infections”; “Shasthya Shebika” AND “Coronavirus Infections”; “Health Assistant” AND “coronavirus infections”; “Community-Based Skilled Birth Attendant” AND “coronavirus infections”; “Community Health Care Provider” AND “Coronavirus Infections”; “Health Extension Worker” AND “coronavirus Infections”; “Health Development Army Teams” AND “Coronavirus Infections”; “Lady Health Worker” AND “Coronavirus Infections”; “Village Health Worker” AND “Coronavirus Infections”; “Village Health Teams” AND “Coronavirus Infections”; “Village Health Volunteer” AND “Coronavirus Infections”; “Home-Based Carer” AND “Coronavirus Infections”; “Lay Counselor” OR “Adherence Counselor” AND “Coronavirus Infections”; “Female Community Health Volunteer” AND “Coronavirus Infections”; “Maternal Child Health Worker” AND “Coronavirus Infections”; “Behvarz” AND “Coronavirus Infections”; “Brigadista” AND “Coronavirus Infections”; “Volunteer Midwives” OR “Volunteer Collaborators” AND “Coronavirus Infections”; “Health Promoters” AND “Coronavirus Infections”; “Community Health Volunteer” AND “Coronavirus Infections”; “Community Health Assistant” AND “Coronavirus Infections”; “Community Based Agent” AND “Coronavirus Infections”; “Health Surveillance Assistant” AND “Coronavirus Infections”; “Agentes Polivalentes Elementares” AND “Coronavirus Infections”; “Community health representatives” AND “Coronavirus Infections”; “Aboriginal health workers” AND “Coronavirus Infections”; “Community health aides” AND “Coronavirus Infections”; “Community navigators” AND “Coronavirus Infections”; “Health trainers” AND “Coronavirus Infections”; “Paraprofessional home visitors” AND “Coronavirus Infections”; “Community nutrition workers” AND “Coronavirus Infections”; “Barangay Health Workers” AND “Coronavirus Infections”.

Subsequently, we filtered studies in English, Spanish, and Portuguese, published between January 1, 2020, and December 31, 2020. The reviewers performed the search strategies individually, with the following inclusion criteria: studies focusing mainly on the work of CHWs in the Covid-19 pandemic; studies published in 2020; and studies in Portuguese, Spanish, or English. On the other hand, the exclusion criteria were studies that do not objectively mention the role of CHWs in the pandemic; studies that mention the CHWs, but do not provide any information that answers the guiding question and the analytical categories; studies whose descriptor is synonymous with CHWs, but the professional object of the study is another actor.

The research was carried out in three steps by two evaluators (L.M and R.C), and disagreements regarding the inclusion or exclusion of the studies were resolved with discussion and the search for consensus. Any unresolved disagreement would require the opinion of a third reviewer (P.C). The first step of identifying the studies was conducted by searching the databases using Boolean descriptors and operators mentioned above, followed by a search for studies in their bibliographic references, for new inclusions, with subsequent elimination of duplicates. The second step consisted of selecting the studies after evaluating the titles and abstracts, reaching the definition of studies for full-text reading. The third step analyzed the full texts and selected those included in the review based on the inclusion and exclusion criteria.

After establishing the corpus of this review, all the studies included were systematized in a standard form in Excel®, stratified into predefined categories inductively^{1818 Galiazzi MC, Sousa RS. A dialética na categorização da análise textual discursiva: o movimento recursivo entre palavra e conceito. Rev. Pesquisa Qualit. 2019 [acesso em 2021 fev 2]; 7(13):1-22. Disponível em: https://editora.sepq.org.br/rpq/article/view/227
https://editora.sepq.org.br/rpq/article/...} : practices, training, working conditions, and legitimacy. Underlying categories were delimited throughout the reading and systematization process and are shown in tables 2 and 3.

Results

The search and selection process of studies followed the JBI recommendations and the checklist adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma)^{1212 Joanna Briggs Institute. Methodology for JBI Scoping Reviews - Joanna Briggs 2015. Australia: JBI; c2015. [acesso em 2021 jul 11]. Disponível em: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf
https://nursing.lsuhsc.edu/JBI/docs/Revi...} . A total of 326 studies were identified, 4 of which were indexed in SciELO, 270 in Medline, 7 in Lilacs, 8 in Embase, and 37 in Cochrane. A new inclusion was performed by manually screening the reference list in the selected studies (1), followed by eliminating duplicate studies (9). A total of 318 studies were selected for reading titles and abstracts, and 238 papers were excluded, leaving 35 studies for reading in full. Then, six studies were excluded because they did not meet the inclusion criteria, with the appropriate justifications, leaving out a final sample of 29 studies, which we included in this scoping review (figure 1).

Table 1 presents a summary of the information from the 29 studies included, in which the following distribution was verified regarding the countries/backdrop of the CHWs’ action: seven in Africa (South Africa, Liberia, Nigeria, and Zambia), four in South America (Brazil and Peru), nine in North America (U.S.), four in Asia (India, Philippines, and Vietnam), one in Europe (England) and four without a specified setting. The scoping review included literature review studies (3), qualitative research (13), cross-sectional studies (1), and opinion articles in academic journals (12).

Comprehensive and diverse practices in the Covid-19 pandemic

According to the literature we reviewed, the CHWs engaged in diverse activities, varying per the preexisting professional settings and profiles (table 2). Care practices during the pandemic involved the continuity or restoration of programs to support sexual and reproductive health and mother and child care^{1919 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/
https://pubmed.ncbi.nlm.nih.gov/32559276... ,2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,3434 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... ,4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...} .

The integrated management of cases of infectious diseases such as malaria and tuberculosis, and preexisting chronic conditions such as hypertension, diabetes, HIV, epilepsy, and disabilities, have been recorded in the literature, many of which are risk factors for the aggravation of Covid-19^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2222 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,2828 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... ,4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} . In this sense, home delivery of medicines has become a practice of CHWs in some countries, minimizing the travel of these groups to services and the risk of contracting the new coronavirus^{2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,2727 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/
https://pubmed.ncbi.nlm.nih.gov/32501022... ,2828 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...} .

Monitoring and support in mental health for those who suffer from substance abuse disorders, depression, anxiety, and distress due to bereavement involved actions such as facilitating prescription renewal, scheduling appointments with primary care and mental health providers, such as home visits, telephone monitoring, and traditional healing, in the case of indigenous communities<sup>2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.

24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10.... -2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,3434 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,4040 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137... ,4141 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729... ,4646 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024...</sup> .

Home or peridomiciliary visits to monitor patients were interpreted as a dilemma, with some countries maintaining them, others reducing or interrupting them, replacing them with telemonitoring^{2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,3232 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance... ,3434 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0...} . Diagnostic support interventions with temperature, blood pressure, and oximetry measurements were suggested in England^{2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30...} , discussing a proposal to implement CHWs in its health system. Although such practices are foreseen in Brazil, they will only be implemented through training, availability of Personal Protective Equipment (PPE), and equipment^{2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.}.

Regarding introducing vaccines and any treatments that may arise for Covid-19, the literature recommends that CHWs contribute to the preparation of health systems and communities^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} . Health surveillance involved carrying out contact tracing, isolation, quarantine, and curfews, based on tribal mandates<sup>2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550...

21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...

22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... -2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,2626 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,2828 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,2929 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl... ,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,4141 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...

42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... -4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... ,4545 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...</sup> , besides monitoring patients and caregivers for the clinical deterioration of Covid-19<sup>2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2222 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100...

23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.

24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10.... -2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,3838 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,4040 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137... ,4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...</sup> . CHWs performing tests were not reported in any study. Environmental surveillance, using single health approaches^{2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...} , was recommended, with reports of jaundice screening, advice on drinking water, and distribution of chlorine solution^{4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...} , besides support for disinfecting surfaces in communities^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2222 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} and working in sanitary barriers^{4141 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...} .

Several studies also mentioned the role of CHWs in data collection to understand the pandemic’s impact^{2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... ,4646 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} , which suggests the huge local and national importance of these workers for diagnoses closer to reality. Another important role is related to health education and communication on signs, symptoms, and transmission routes of the virus^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2222 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,2828 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,3434 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,3939 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... ,4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... ,4646 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} , acting as a bridge to access to the formal health system and telemedicine^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2222 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,3838 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,4646 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} .

In social communication, many studies mentioned the importance of combating misinformation, fake news, fear, stigma towards sick people, and distrust vis-à-vis the health system and vaccines<sup>2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....

43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... -4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...</sup> . Strategies were developed in urban and rural areas, including printing educational leaflets and making them available in places of permanent circulation, writing hand hygiene instructions to fix on the walls, postings on social networks, disseminating information on bicycles or sound cars, radios, and community newspapers^{2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...} .

A different role in the communicative dimension concerns the linguistic and cultural translation of health protocols and their role as interpreters for doctors in countries with large numbers of immigrants^{3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,3838 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,4141 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} , or huge diversity of dialects^{3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...} . Internally to the PHC services, they organized service flows to avoid crowding^{2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.}. Many studies have described the role of intersectoral actions and social mobilization, such as the delivery of food, cleaning supplies, PPE, and social support for access to income, housing, and employment<sup>2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2222 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100...

23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.

24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10.... -2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,3838 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,3939 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl... ,4141 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... ,4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...

44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre... -4545 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020...</sup> .

Identifying and articulating support in domestic violence situations was also recorded in the reviewed studies since, commonly, CHWs are the first contact in cases of domestic harassment^{3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,4040 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137... ,4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...} . In the U.S., they linked clients with legal assistance, including advisory services to regularize their immigration status and explain complex eligibility requirements for various government programs, highlighting advocacy as an essential practice of CHWs^{3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,3838 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20...} .

Professional qualification for new socio-sanitary needs

Nine studies recommended training to qualify the performance of CHWs in the Covid-19 pandemic<sup>1919 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/
https://pubmed.ncbi.nlm.nih.gov/32559276...

20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550...

21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...

22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100...

23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.

24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10.... -2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,4545 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020... ,4646 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024...</sup> , 16 mention concrete qualification experiences carried out in different countries<sup>2626 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,2727 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/
https://pubmed.ncbi.nlm.nih.gov/32501022... ,3030 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177...

31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...

32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance...

33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.

34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0...

35 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/
https://pubmed.ncbi.nlm.nih.gov/32858726...

36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... -3737 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679... ,4040 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137...

41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...

42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....

43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... -4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...</sup> , while four studies did not mention any training offer^{2828 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,2929 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl... ,3838 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,3939 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl...} (table 3).

One study suggests continuous training, information sharing, and updates through different means, considering frequent changes in protocols during the pandemic^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550...} . In-service training involved PHC professionals in India, Brazil, and Peru^{3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,3434 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...} , and local and national instructors in Vietnam^{4545 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020...} . The offer of courses by educational institutions specialized in the field was recommended in England^{2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30...} and conducted by the University of New Mexico in the U.S.^{3737 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679...} . Most studies suggest using distance learning^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,3737 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} as an alternative, mentioning the Indian experience of a new Integrated Government Platform for online training^{4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} .

The reviewed literature presents objectives and content to be considered, such as acquiring knowledge and skills to prevent, detect, and control coronavirus infection^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2222 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,3434 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,4646 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} ; use of the Internet and applications^{2323 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.}; assessments of cognitive, physical, and emotional impairments in older adults post-hospitalized due to Covid-19^{2424 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10....} ; first aid and emergency assessment^{2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30...} ; myths and truths around testing and treatment for Covid-19^{3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,3737 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679...} ; and proper use of PPE^{3737 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679...} .

A significant issue is the lack of minimum standardization regarding these workers’ previous and general training. In Philadelphia, U.S., a high school diploma, and an empathetic personality are required, besides offering a month of training in skills such as motivational interviewing^{4040 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137...} . Indiana, U.S., has a nine-month course to become a CHW, followed by certification^{3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922...} . In the Navajo Nation, U.S., all nursing assistants are certified trained as CHWs in the New Mexico Department of Health^{4141 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...} .

Notably, the lack of training was identified as a significant barrier to the provision of effective services in other epidemics^{2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...} , which seems to be repeated in the current pandemic. In Brazil, only 9% of CHWs have allegedly received training after four months of the pandemic^{3232 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance...} . In Nigeria, an assessment of knowledge and practices related to Covid-19 revealed gaps that suggest negligence in the qualification of these professionals^{3030 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177...} .

Work conditions in the Covid-19 pandemic

We identified five studies (table 3) that mention the substandard working conditions of CHWs in the pandemic^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2626 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,3232 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance... ,3434 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} , including insufficient PPE^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,2626 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,3232 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance... ,3434 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} , low wages^{3232 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance...} , or even delayed payment, prejudice, high workload, and lack of psychosocial care^{4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} . Consequently, attention is drawn to the fact that many CHWs may not be willing or unable to take on additional tasks during the pandemic^{4646 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024...} .

In India and Africa, experiences revealed a lack of infrastructure and insufficient basic supplies for the CHWs to work satisfactorily in the pandemic, harming the safety of these professionals and making them vulnerable to contagion^{2626 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} . On the other hand, the experiences of Vietnam^{3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...} and Liberia^{4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} reveal that their CHWs had access to adequate PPE^{3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} and training in its use^{4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} .

The payment mode worldwide ranged from scholarship holders^{3939 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl...} , salaries^{4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} , pay-per-performance^{2020 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550...} , to volunteering^{1919 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/
https://pubmed.ncbi.nlm.nih.gov/32559276... ,2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...} . The literature suggests that remuneration should be implemented^{1919 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/
https://pubmed.ncbi.nlm.nih.gov/32559276... ,3535 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/
https://pubmed.ncbi.nlm.nih.gov/32858726...} and that other benefits should be considered, such as providing housing subsidies, training^{2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...} , transport to remote areas^{2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,3030 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177...} , and CHWs should be flexible to meet their personal needs and receive paid time off^{3535 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/
https://pubmed.ncbi.nlm.nih.gov/32858726...} .

Women’s poor working conditions were also described and analyzed as a preexisting and escalated issue. As it is a feminized category, it is subject to a greater volume of domestic work in the pandemic and gender-based violence^{2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,3030 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} , such as kidnappings and rapes recorded in rural Nigeria^{3030 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177...} , and other gender prejudice in India^{4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} .

CHWs’ global institutionalization varies and is unspecific per the results of this review and may be linked to Non-Governmental Organizations (NGOs) in South Africa^{2929 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl...} , hospitals, clinics, community organizations, indigenous health services in the U.S.^{3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,3838 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,4040 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137... ,4141 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...} , or local or national health systems in South Africa^{2828 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl...} , Brazil^{3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.}, India^{4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...} , and Vietnam^{4545 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020...} .

The work process can be multidisciplinary in a hospital^{3838 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20...} or PHC setting^{3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} . CHWs can follow-up households ranging from 40 in Zambia^{3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...} , 60-100 in India^{4343 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...} , to 250 households in South Africa^{2727 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/
https://pubmed.ncbi.nlm.nih.gov/32501022...} . The coordination or supervision of these professionals can be conducted by local tribal leaders^{4141 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...} , nurses<sup>2727 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/
https://pubmed.ncbi.nlm.nih.gov/32501022...

28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... -2929 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl... ,3333 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...</sup> , or social workers^{3939 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl... ,4040 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137...} .

Legitimacy before communities, health teams, and national and international authorities

Trust in CHWs’ work and practice in territories, communities, and in their dialogue with national, subnational systems and health services was the main characteristic of legitimacy evidenced in the studies^{2121 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,2222 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,2626 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,3535 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/
https://pubmed.ncbi.nlm.nih.gov/32858726... ,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,3838 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... ,4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} , which makes CHWs important workers in building coping strategies for Covid-19, especially in socially vulnerable regions^{2222 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,2626 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,4747 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} (table 3).

However, challenges are identified in the legitimacy of CHWs in contexts of the political opposition of national authorities to WHO recommendations, as is the case of the Brazilian Republic President^{3232 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance...} . Moreover, there are records of assaults on CHWs in South Africa due to the growing lack of income and food insecurity of the population^{2929 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl...} .

We also identified fears that health professionals may be spreading Covid-19^{2626 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} and other social stigmas as limited knowledge of CHWs in Zambia^{3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...} . In India, health authorities recognize these workers, either with public congratulations or with the approval of legislation against acts of violence against health professionals and anti-stigma campaigns^{4242 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} .

Another aspect that interferes with the legitimacy of CHWs concerns their different belief systems, including indigenous, rural, and immigrant population care settings^{3030 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177... ,3131 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,3434 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,3939 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl... ,4141 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...} , which suggests considering a previous cultural identity when selecting and qualifying professionals for better acceptability in the community. In high-income countries, with increasing immigration, as in the U.S., the importance of mastering the language and the ethnic origin of CHWs is evident, with cases of greater trust and bond with CHWs who master Spanish and recognize the immigration issues of the Latino population served^{3636 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,3939 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl...} .

In March 2020, a global coalition of 16 organizations working with governments in Haiti, Mali, and Nepal issued a stance and technical resource offer document to guide governments to involve CHWs in combating Covid-19^{4444 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} . Converging on what appears to be a global movement, U.S. senators have proposed the creation of a National Health Force to recruit, train, and employ hundreds of thousands of CHWs^{4040 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137...} . In England, the feasibility of implementing a program whose estimated cost would be £2.2 billion a year for 100,000 CHWs^{2525 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30...} is being discussed.

Discussion

The studies in this review had different approaches, practices, characteristics, and challenges of CHWs in the Covid-19 pandemic. However, the results highlight the high scientific production in the U.S., while low and middle-income countries, with a great tradition of CHWs programs^{1515 Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014 [acesso em 2021 fev 2]; 35:399-421. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24387091/
https://pubmed.ncbi.nlm.nih.gov/24387091...} , barely published or did not publish at all, denoting a structural inequality in scientific and educational development between countries.

The pandemic re-presented the importance of CHWs in ensuring a comprehensive, community-based PHC integrated with active surveillance and comprehensive social protection while revealing the distance between the ideal and the actual. This situation is expressed in the large number of attributions that interprofessional teams should perform, not always guaranteed by the health systems, and the substandard work relationships, which reveals that the CHWs are part of a selective PHC strategy^{4848 Giovanella L, Mendonça MHM, Buss PM, et al. From Alma-Ata to Astana. Primary health care and universal health systems: an inseparable commitment and a fundamental human right. Cad. Saúde Pública. 2019 [acesso em 2021 fev 2]; 35(3):e00012219. Disponível em: https://www.scielo.br/j/csp/a/9rWTS9ZvcYxqdY8ZTJMmPMH/?lang=pt
https://www.scielo.br/j/csp/a/9rWTS9ZvcY...} .

In this review, attention is drawn to the lack of specificity of the studies concerning testing for Covid-19, temperature measurement, and oximetry by CHWs, reaffirming the centrality of their practices in non-biomedical care based on education, health promotion, intra, and intersectoral articulation.

Although some studies mention data collection as a CHW practice, they do not reflect on the professional capacity to process and interpret them to intelligently conduct the next step of active and participatory surveillance in the communities. CHWs’ relocation to administrative activities within the services or sanitary barriers outside their coverage territory requires critical reflection. They presuppose decreasing the relationship with the community when more significant contact and empathy are expected, generating trust and legitimacy.

Health education and communication practices were challenged to respond to the context of infodemics and fake news^{4949 The Lancet Infectious Diseases. The Covid-19 infodemic. Lancet Infect Dis. 2020 [acesso em 2021 fev 2]; 20(8):875. Disponível em: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30565-X/fulltext
https://www.thelancet.com/journals/lanin...} , besides inequalities in the access to information technologies in different countries, highlighting the pandemics of this century and CHWs’ need to develop new skills.

Few studies in this review presented the role of CHWs in facilitating access to vaccines against Covid-19 or specific training to better act in the face of anti-vaccine movements, which is justified by the study period that did not cover the vaccination phase of the world population, started in December 2020 in the U.K. Likewise, the approach to post- Covid sequelae and mental illness requires further investigation, especially on how CHWs can carry them out.

The number of intersectoral articulation and community mobilization experiences developed by the CHWs in coping with the health-disease process determinants is notorious, which leads us to reflect on charitable solidarity and the importance of establishing short, medium, and long-term public policies on food security and universal basic income in national states and international organizations. In this regard, we highlight the advocacy activity undertaken by CHWs in some countries, which can be better investigated as an analytical category in other comparative studies.

Unlike the paths of other health categories, in general, the work of CHWs did not move towards professionalization, which significantly collides with low definition regarding the curricula of their general education^{88 World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. [Local desconhecido]: World Health Organization; 2018.}. While the health crisis is an opportunity for a more significant opening for such investments, the reviewed literature brought few elements regarding the training processes offered, lacking further studies to understand the character and impact of the training developed in the pandemic responses.

Furthermore, the popular origin, feminization, and poor working conditions are hallmarks of CHWs in many contexts, reflecting the reality of the communities where they are inserted, on the one hand, and, on the other, the frequent social and sexual division of work in the health sector in many countries^{5050 Shannon G, Minckas N, Tan D, et al. Feminisation of the health workforce and wage conditions of health professions: an exploratory analysis. Hum Resour Health. 2019 [acesso em 2021 fev 2]; 17(1):72. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31623619/
https://pubmed.ncbi.nlm.nih.gov/31623619...} . This reality points to the relevance of combining political struggles for better community living conditions with struggles for better working conditions, especially in pandemic contexts.

Final considerations

The findings of this review are presented as a subsidy for formulators and implementers of health policies and workers who require evidence to better support their negotiation agendas. It is also relevant to researchers in the field, as it points out gaps that must be better explored in future research projects.

A limitation of this study was the poor historical contextualization of CHWs’ institutionalization and the pandemic backdrop in each country, given the coverage. The authors suggest conducting evaluative studies on the efficacy and effectiveness of CHWs, which could better support decision-makers for allegedly frequent pandemic settings.

Ultimately, we emphasize that CHWs’ future is nested in the dispute throughout the health care model in each country and the scope of social protection systems, insofar as the effectiveness of their actions depends on economic, social, and political support through broad and general struggles within society.

References

Publication Dates

History