Community Health Workers Connect Patients to Care in U.S. COVID Response

Maria Plata, an Immokalee, Fla., native and daughter of a Mexican farm worker, was one of millions of Americans who lost their job when COVID-19 hit in early March. But several months later, she found a new opportunity among the first cohort of community health workers hired by Healthcare Network, a local health care provider, and trained by Partners In Health to support her community’s response to the virus.

A fluent Spanish speaker, Plata began going door-to-door in Immokalee, where the majority of residents are Hispanic, answering questions and dispelling rumors about the pandemic.

“Some believe that if you go to the hospital, you will die, or that you can get COVID-19 from being tested,” Plata says.

Plata is among six community health workers, or CHWs, connecting residents with care in Immokalee, a largely immigrant, farm worker community of roughly 27,000 people. There, the virus spread rapidly among those living and working in crowded conditions, often with little to no institutional supports, such as PPE or paid sick leave. For some, especially the undocumented and uninsured, there is reluctance to access health care services.

It’s a story often repeated by officials in 15 locations across North America with which PIH has partnered to launch a more robust response to the COVID-19 pandemic. These efforts are part of the newly created U.S. Public Health Accompaniment Unit (PHAU), which provides technical expertise and training to state and local governments on effective testing, contact tracing, quarantine, and social support—such as food, housing, or financial assistance. The unit also offers free online resources through its Learning Collaborative and advocates at the highest levels of government for public policy that ensures an equitable response to the global pandemic.

A critical element to this work is the creation of local teams of CHWs, who connect residents to the information they need to prevent infection or access care. So far, 4,234 CHWs and contact tracers have been hired in hard-hit places like Immokalee and across at least three other locations, including: Navajo Nation; North Carolina; and Montgomery, Ala. 

Dispelling rumors, allaying fears

CHWs form the backbone of PIH’s work globally and have made the difference in connecting patients with care during other infectious disease outbreaks, such as multidrug-resistant tuberculosis (TB) in Peru and Ebola in West Africa. The same is proving true in PIH’s efforts to stop the spread of COVID-19 in the United States.

Dr. Fernet Leandre, a TB and HIV expert and chief program officer at Zanmi Lasante--PIH’s sister organization in Haiti--has been working in Immokalee for several months and helped train the first CHW team, which will soon expand with six more hires. The team supports COVID-19 testing, makes referrals to the local clinic, and canvasses door-to-door to provide COVID-19 prevention education. He says CHWs, who must be culturally competent and are often multilingual, are critical to building trust in the health system and connecting people to medical care.

In Immokalee specifically, fears that testing or hospitalization could result in deportation are widespread, so listening to and addressing such fears are key parts of CHWs’ work. CHWs assure people access to care, regardless of citizenship status.

Leandre says PIH has learned from its global experience that letting community members and local partner organizations inform and guide pandemic response has helped build trust and willingness to engage with the public health system. Partnership with local and grassroots organizations also promotes buy-in across the community.  

“Once we showcase what works,” Leandre says. “We can scale up and have more buy-in from local officials.”

Launching a statewide team

In North Carolina, PIH is working with the Department of Health and Human Services and the Office of Rural Health to improve the statewide COVID-19 response, working primarily with marginalized populations, including Latinx, Black, migrant, and farm worker communities.

Dr. Devin Worster, who is overseeing PIH’s response there, says a successful statewide contact tracing system must come hand-in-hand with support for individuals and families in quarantine. CHWs identify and connect patients with resources, such as food and financial relief payments, to allow for safe quarantine or isolation. With PIH’s support, North Carolina officials have contracted seven community organizations to hire and train more than 400 CHWs.

“As trusted members of the community,” Worster says, “CHWs are best equipped to reach the most vulnerable, understand their needs, and coordinate connections to essential supports.”

In Durham, CHWs recently helped a family in need of urgent social support. The team at Curamericas Global connected a disabled mother who was diagnosed with COVID-19, along with her two children who also fell ill, to Duke University Health System and a local nonprofit called Gang Free Inc, which provided boxes of food, PPE and sanitation supplies, and a one-time financial relief payment. The family called to express their gratitude. One CHW who accompanied the family recalled that the experience “was extremely emotional, in a good way.”

Back in Immokalee, Plata had similar good news to share. She recently met an immigrant mother of two who was threatened with eviction after losing her job due to COVID-19 and falling behind on rent. She was able to link her to a local organization called Misión Peniel, which stepped in with emergency rent and food assistance.

For Plata, the family’s example was a powerful reminder of the importance of partnership: “I was so happy that we were able to make that connection.”