Abstract
OBJECTIVE: To report experiences in Bihar, India's most densely populated state, with a state government programme to train community health workers (CHWs) to combat the coronavirus disease 2019 (COVID-19) pandemic in the state's predominantly rural population of 128 million. METHODS: In May 2021, during the second wave of the COVID-19 pandemic in India, the Bihari government initiated a 1-day COVID-19 training programme for rural, unaccredited CHWs who had recently completed a community health education course from the National Institute of Open Schooling. The use of primary health centre buildings and doctors to deliver COVID-19 training and the existence of certification data on CHWs who participated in the community health education course streamlined implementation and minimized costs. After COVID-19 training, CHWs were paid as first responders and COVID-19 treatment workers by the Bihari government. FINDINGS: Overall, 15 000 CHWs in Bihar completed the COVID-19 training programme in 2021 and a further 30 000 were enrolled. A survey of CHWs carried out after COVID-19 training had started found that 80% (81/102) were satisfied with training and felt they were receiving information from reliable sources. CONCLUSION: The training and mobilization of a team of CHWs helped ease pressure on a stressed, rural, health-care system in Bihar and improved its preparedness for future COVID-19 outbreaks. The success of the training programme illustrates how local initiatives can help address gaps in the health workforce and extend the reach of public health care into rural areas, in addition to improving COVID-19 responses.