Navigating fear and care: The lived experiences of community-based health actors in the Philippines during the COVID-19 pandemic

The activities of community-based health actors are widely recognized as critical to pandemic response; yet, there exists a lack of clarity concerning who is included in this ecosystem of actors and how these actors experience the complexity of delivering community-level care in the context of a public health emergency.

Abstract

The activities of community-based health actors are widely recognized as critical to pandemic response; yet, there exists a lack of clarity concerning who is included in this ecosystem of actors and how these actors experience the complexity of delivering community-level care in the context of a public health emergency. The objectives of this study were (1) to characterize the lived experiences of community-based health actors during the COVID-19 pandemic in the Philippines; and (2) to identify opportunities for further supporting these critical actors in the health workforce. Virtual semi-structured interviews were conducted (January–February 2021) with 28 workers employed by a Philippines-based non-governmental organization (NGO) to explore their lived experiences during the COVID-19 pandemic.

Data were analyzed thematically using a hybrid inductive-deductive coding process, informed by Tronto’s conceptualization of an ethic of care. Lived experiences among study participants were shaped by discourses of fear and care, and the interaction between these two affects. Participants reported everyday experiences of fear: NGO workers’ fears of contracting and transmitting COVID-19 to others; perceived fear among community members where they worked; and fears around COVID-19 testing, recognizing the personal and social implications (e.g. stigma) of a positive test.

Authors

Warren Dodd, Laura Jane Brubacher, Amy Kipp, Sara Wyngaarden, Victoria Haldane, Hannah Ferrolino, Kendall Wilson, Danilo Servano Jr., Lincoln Leehang Lau, Xiaolin Wei

Introduction

The COVID-19 pandemic has challenged health systems worldwide and exacerbated pre-existing gaps within health service delivery. Increased community engagement, vis-à-vis extending health services into local communities, has been called for as a means of strengthening health systems, particularly in resource-constrained settings (Gilmore et al., 2020; Haldane et al., 2021a; World Health Organization [WHO], 2021).

Throughout the COVID-19 pandemic, non-governmental organizations (NGOs) and other civil society actors have played crucial roles in many low- and middle-income countries (LMICs). These non-state actors have provided an array of community-based functions to bolster government-led emergency response efforts, such as coordinating humanitarian relief, communicating public health messaging within local jurisdictions, and supporting illness prevention and case management in communities (Cai et al., 2021; Dodd et al., 2021a; Osuteye et al., 2021). This community-based work has filled critical gaps in state capacity at a time when resources are stretched thin and has helped to address the direct and indirect health consequences of the COVID-19 pandemic.

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