Due to the COVID-19 pandemic, 1.4 million fewer people received care for TB globally in 2020 compared to 2019. There has been no documented evidence of community-led interventions to fill in the gaps for TB high-burden countries as COVID-19-related barriers disrupted care. As a result, Matahari was engaged by the Global Coalition of TB Advocates (GCTA) to document, analyse, and write-up experiences of TB community health workers (CHWs), most of whom are *unpaid*, in terms of their promotive and clinical roles in ensuring TB communities are linked to diagnostics, treatment, and care. Matahari travelled to Kenya, engaging TB communities and documenting their experiences in depth, GCTA conducted interviews in India and Indonesia, and project partner KHANA interviewed communities in Cambodia.
Findings include:
- CHWs providing TB services innovated by delivering drugs to homes, conducting online counselling, and jointly conducting COVID and TB awareness activities. Ministries of Health innovated by allowing longer take-home doses of TB medications and facilitating medicines pick-up if individuals were locked down in different states.
- CHWs TB duties include home delivery of medications, referral to testing, psychosocial support, counselling, supply of food, advocacy with local authorities, and other duties. Some worked at night to avoid individuals being marked by neighbours as potentially having COVID – and work was mostly done by foot. In all countries, community health workers worked unpaid or for minimal stipends. The majority of CHWs interviewed were women. In several cases, community health workers told of needing to spend their own money to provide food to TB communities so they could remain on TB medications. (Cambodia, India, Indonesia, Kenya)
- Due to the door-to-door nature of work by CHWs, they were particularly vulnerable to police harassment, violence, arrests, and extortion during COVID lockdowns and curfews. This included arrests due to non-masking, despite some CHWs stating that they could not afford masks. CHWs also reported having insufficient supplies of PPE in the initial stages of the pandemic. (India, Kenya)