Lay Community Health Workers (LCHWs) provide a human element to the healthcare system and strategically positioned to bridge the gap between community members and healthcare providers

Teresa Elizabeth Leslie^1*Jayaprakasam Madhumathi²

• ¹University of Vermont Extension, Burlington, United States
• ²Indian Council of Medical Research, New Delhi, India

Lay Community Health Workers (LCHWs) provide a human element to the healthcare system and strategically positioned to bridge the gap between community members and healthcare providers. In resource poor settings, LCHWs are the major workforce that connects people with health and social services, conducts health education in community settings, promotes healthy behaviors, advocates for community members, provide social support, screen for active cases and assist individuals when navigating often complex healthcare systems1. LCHWs are also often utilized in providing metal health services2. The articles in this edition of Frontiers in Tropical Diseases not only provide examples of how LCHWs can assist in the prevention/control/treatment of NTDs, but also provide valuable lessons for those in the global North, where healthcare remains over reliant on the biomedical at the cost of the human element. The articles by Barry et al, Ahmed et al, and Mobona et al on soil transmitted helminthiasis (STH), cutaneous leishmaniasis (CL), and human rabies, identify areas where LCHWs can aid with the prevention/control/treatment. In Ghana Barry et al describe that, while Mass Drug Administration (MDA) is recommended by WHO, the lack of information on MDA, medication benefits, and motivation are major challenges to implementing MDA programs. They emphasize the utilization of community outreach to provide education on the benefits of MDA and address gaps in community perspectives and knowledge related to STH and MDA. Through a systematic review and meta-analysis, Ahmed et al aimed to determine the pooled prevalence and associated determinants of CL in East Africa. The authors found that the combined prevalence of CL was high indicating an urgent public health need for targeted initiatives to prevent and mitigate disease impact. High CL risk results from regional climate in rural and semi-urban areas providing favorable conditions for sand fly vectors, the perceived self-healing nature of CL, poverty, and insuSicient public health infrastructure. LCHWs could potentially fill this gap and assist with prevention and treatment through education and outreach Collaboration between governments, health organizations, and communities is also crucial for eSective management/control of CL. Mabona et al explore how Traditional Health Practitioners (THPs) are trusted stakeholders in the eThekwini District in KwaZulu-Natal Province, South Africa and play an important role in the prevention and treatment of dog mediated rabies. In rural areas, people tend to seek healthcare from THPs prior to utilizing conventional healthcare facilities. THPs exhibited good attitudes about rabies prevention/treatment but knowledge gaps specifically existed surrounding referral practices for post-exposure prophylaxis (PEP). The article illustrates the need for open collaboration between THPs and conventional healthcare and on-going formal THP training to increase PEP referrals PEP. Two articles by Tossou et al and Sidamo et al suggest how LCHWs can assist when preventing NTD's among people with disabilities (PWDs) and supporting the mental health of caretakers. Tossou et al describe the insuSicient management and lack of support for the majority of PWDs with skin NTD's in the Benin and Côte d'Ivoire region. They emphasize a need for building comprehensive and sustainable interventions into public health programs aimed to improve the well-being of PWD. The authors stress the significance of exploring socioeconomic influences, access to management/care, and pilot programs integrating solutions aimed at the needs of PWD's. Many of these suggestions can be supported and fulfilled through the work of LCHW's. Sidamo et al describe family caregivers of patients with NTDs and mental health conditions as "hidden patients" in Ethiopia and find that caregivers face multifaceted social, psychological and economic challenges. The authors emphasize that strengthening coping mechanisms through tailored interventions could significantly enhance caregivers' overall well-being. These services could be supported by LCHWs oSering community-based resources and training to bolster caregivers' coping skills and connect them with relevant support networks. The inclusion of public awareness campaigns could also focus on decreasing stigma and promoting social inclusion. The articles by Yeboha-Manu et al and Makau-Barasa et al are critically important considering the funding shortages caused by the elimination of USAID. Both articles speak to the need for institutional and policy development in the global tropical South by those who live in the global tropical South. While not directly referencing the work of LCHW's, the articles highlight the significance of local, regional, and national institutions taking a leadership role in the prevention and control of NTDs. Yeboha-Menu et al describes the accomplishments of the Memorial Institute for Medical Research (NMIMR), a semiautonomous institute of the College of Health Sciences, University of Ghana, Legon and how it serves as an example of the way "African institutions will lead on the road to end neglected tropical diseases" and Makau-Barasa et al discuss how the elimination of NTD's will not occur without a concerted eSort and plan to ensure that the most aSected countries have a robust clinical, public health, laboratory, pharmaceutical, and research capacity to ensure that the last mile towards reaching elimination is not only reached, but sustained. They emphasize how African-based national non-governmental organizations, the private sector, research institutions, and governments must play a vital role as they work to attain ambitious NTD elimination/control goals put forward by the global health community. When working with at risk communities, building institutions, and developing policy, the role of LCHW should be prioritized to bridge the gap with the more biomedical components of the healthcare system. While LCHWs encourage trust and provide culturally appropriate care, they also preserve the human element. LCHW's are trusted members of the communities they serve and provide outreach, education, and support to improve health outcomes and access to services. While the significant role of LCHWs in the global North has not yet been fully recognized, the activities of those in the tropical global South can act as a model of humanity in healthcare system, a prerequisite for health equity.