This is, in part, because of context and systems factors including a country’s previous experience with epidemics, its health system strength and structure, and the onset of SARS-CoV-2 in-country. These and other factors helped shape each country’s COVID-19 response, as well as its ability to continue delivering EHS in the first two years of the pandemic. However, these context and system factors cannot be easily changed during the onset of an infectious disease outbreak, and as a result this cross-country synthesis primarily focuses on the interventions countries implemented in response to COVID-19. A full list of cross-cutting interventions (called “promising practices”) that all or most countries implemented can be found in the table below. Click on the blue cells of the table to see examples of the promising practices in each country.

Cross-Country Promising Practices

Exemplars in Global Health.

This section describes two key cross-cutting patient-level measures that all or most of the six countries implemented in some form. These interventions were widely available, and they supported community well-being as well as individual health. More important, they represent new and adapted ways of meeting the novel patient needs the COVID-19 pandemic caused.

Mental health and psychosocial support programs boosted community well-being.

Prolonged lockdowns, quarantines, curfews, and social distancing measures endangered the mental health and well-being of people of all ages. Most countries we examined implemented programs and policies designed to increase awareness of the pandemic’s mental health effects and to improve access to mental health services. Some countries also focused interventions on particular demographic groups such as children and young people.

For example, in Costa Rica, the Ministry of Health, College of Psychology Professionals, and 911 Emergency System established a Psychological Support Office and 24-hour hotline for those needing mental health support.

From the beginning of the COVID-19 pandemic, Sri Lanka prioritized mental health and psychosocial well-being for the general population as well as for health workers. For instance, officials extended the National Mental Health Helpline to all districts, and public and private partners delivered continued access to essential mental health services and medications. Officials also developed guidelines for health administrators to promote and protect the mental well-being of frontline health workers.

In Uganda, the NGO Save the Children provided psychosocial support to children via phone calls, home visits, and radio messages. Also, “Obuntu bulamu,” a public project that aims to improve participation, inclusion, and quality of life for children with disabilities in Central Uganda, implemented a peer-to-peer support intervention that included nondisabled peers, parents, and teachers.1 Community health workers were encouraged to provide psychosocial support to all patients.

Community health workers (CHWs) delivered key health and support services, especially to those living in hard-to-reach areas.

In most of the six countries, preexisting cadres of CHWs provided a wide variety of support services to individuals and communities. They performed contact tracing and community surveillance; served as a trusted source of risk communication and public health information; followed up with those who tested positive for (or displayed symptoms of) COVID-19; delivered COVID-19 vaccines, especially to those in rural or isolated areas; and provided psychosocial support to patients of all ages.

For instance, CHWs known as asistentes técnico de atención primaria, or ATAPs, have been long-standing members of Costa Rica’s primary care workforce. ATAPs supported COVID-19 response efforts by conducting case counts in their communities, implementing quarantine orders, and delivering vaccines—particularly in remote and hard-to-reach areas.2

Village health volunteers (VHVs), a national network of more than a million trained CHWs in Thailand, played an important role in the country’s COVID-19 surveillance, risk communication, and personal protective equipment distribution activities.3 According to one study, VHVs went to over 14 million households during March and April 2020 as part of community surveillance efforts.4 VHVs also helped maintain the uninterrupted delivery of EHS nationwide.

Uganda’s network of CHWs, known as village health teams (VHTs), had been trained on infection control and prevention strategies during earlier epidemics. Consequently, they played a key role in the country’s COVID-19 response. VHTs supported surveillance and contact tracing activities, helped maintain EHS by taking on nonmedical tasks (such as temperature screening) from other health workers, and supported several other aspects of Uganda’s pandemic response.5

In addition to supporting COVID-19 response efforts, CHWs also helped deliver EHS. For example, Ghana leveraged a preexisting network of nearly 30,000 CHWs during the pandemic6 to deliver EHS through home visits. They also helped patients with mild or non-life-threatening health conditions learn how to manage their treatment at home so they could avoid visiting health facilities unnecessarily.

Community health nurses, Priscilla Osei and Juliana Akumatey visit homes, schools, lorry stations and wherever they can find people to vaccinate against COVID-19 on June 3, 2022.
Community health nurses, Priscilla Osei and Juliana Akumatey visit homes, schools, lorry stations and wherever they can find people to vaccinate against COVID-19 on June 3, 2022.
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  1. 1
    Ghent University Department of Special Needs Education. Obuntu bulamu. Accessed December 1, 2022.
  2. 2
    Center for Strategic and International Studies. Building a resilient health system: Costa Rica's 80 year experiment. Published October 19, 2021. Accessed January 12, 2023.
  3. 3
    Narkvichien M. Thailand's 1 million village health volunteers-"unsung heroes"-are helping guard communities nationwide from COVID-19. World Health Organization News. August 28, 2020.
  4. 4
    Kaweenuttayanon N, Pattanarattanamolee R, Sorncha N, Nakahara S. Community surveillance of COVID-19 by village health volunteers, Thailand. Bull World Health Organ. 2021;99(5):393-397.
  5. 5
    Uganda Ministry of Health (MOH). Operational Guidelines on COVID-19 for Village Health Teams (VHTs). Kampala: MOH; 2020. Accessed December 1, 2022.
  6. 6
    Schwarz D, Kim JH, Ratcliffe HL, et al. The status of Ghanaian community health workers' supervision and service delivery: descriptive analyses from the 2017 Performance Monitoring and Accountability 2020 survey. Gates Open Res. 2019;3:1468.