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. 2023 Oct;8(10):e012727.
doi: 10.1136/bmjgh-2023-012727.

Hear my voice: understanding how community health workers in the Peruvian Amazon expanded their roles to mitigate the impact of the COVID-19 pandemic through community-based participatory research

Tina Samsamshariat  1   2 , Purnima Madhivanan  3 , Alexandra Reyes Fernández Prada  4 , Eva M Moya  5 , Graciela Meza  6 , Stefan Reinders  7   8 , Magaly M Blas  9
Affiliations

Hear my voice: understanding how community health workers in the Peruvian Amazon expanded their roles to mitigate the impact of the COVID-19 pandemic through community-based participatory research

Tina Samsamshariat et al. BMJ Glob Health. 2023 Oct.

Abstract

Introduction: The COVID-19 pandemic led to the collapse of the Peruvian health system, disrupting healthcare access for indigenous communities in the Amazon. Our study analysed how community health workers (CHWs) from indigenous communities in the Peruvian Amazon expanded their roles to mitigate the effects of the COVID-19 pandemic.

Methods: Fourteen CHWs from Loreto, Peru, participated in a community-based participatory research project using Photovoice, a technique encouraging vulnerable groups to take photos and develop stories illustrating their lived experiences. Participants were recruited from Mamás del Río, a local university-based programme, through purposive sampling. CHWs were asked to photograph how the pandemic affected their lives and work. Participants met four times over 5 months to share photos and develop action items. Data were organised into key themes using thematic analysis. CHWs shared photo galleries with policy-makers in Loreto and Lima.

Results: CHWs produced 36 photos with 33 texts highlighting their roles during COVID-19. Three core themes emerged: the (1) collapse of health infrastructure, (2) use of medicinal plants versus pharmaceuticals and (3) community adaptations and struggles. The leadership of CHWs emerged as a cross-cutting theme as CHWs supported COVID-19 efforts without government training or resources. CHWs asked policy-makers for formal integration into the health system, standardisation of training and management of community pharmacies.

Conclusion: CHWs demonstrated their leadership and expanded their roles during the pandemic with little to no training from the government. Global investment in robust CHW programmes can fortify healthcare delivery.

Keywords: COVID-19; descriptive study; health policy; health systems; qualitative study.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Map of Loreto including the study sites, the communities involved, and their geographic relation to Iquitos.
Figure 2
Figure 2
The health post.
Figure 3
Figure 3
The community medicine cabinet.
Figure 4
Figure 4
Family responsibility.
Figure 5
Figure 5
Visiting COVID-19 patients.
See this image and copyright information in PMC

References

    1. Álvarez-Antonio C, Meza-Sánchez G, Calampa C, et al. . Seroprevalence of anti-SARS-CoV-2 antibodies in Iquitos, Peru in July and August, 2020: a population-based study. Lancet Glob Health 2021;9:e925–31. 10.1016/S2214-109X(21)00173-X - DOI - PMC - PubMed
    1. Neyra-León J, Huancahuari-Nuñez J, Díaz-Monge JC, et al. . The impact of COVID-19 in the healthcare workforce in Peru. J Public Health Policy 2021;42:182–4. 10.1057/s41271-020-00259-6 - DOI - PMC - PubMed
    1. Taylor L. Covid-19: why Peru suffers from one of the highest excess death rates in the world. BMJ 2021;372:611. 10.1136/bmj.n611 - DOI - PubMed
    1. Schwalb A, Seas C. The COVID-19 pandemic in Peru: what went wrong? Am J Trop Med Hyg 2021;104:1176–8. 10.4269/ajtmh.20-1323 - DOI - PMC - PubMed
    1. Dyer O. Covid-19: Peru’s official death toll triples to become world’s highest. BMJ 2021;373:1442. 10.1136/bmj.n1442 - DOI - PubMed

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