CDC-Supported National Network of Farmworker-Serving Organizations to Mitigate COVID-19

Abstract

The Centers for Disease Control and Prevention has partnered with the National Center for Farmworker Health to respond to the impact of COVID-19 on US farmworker communities. Immigrant farmworkers are often isolated from public health infrastructure. This partnership built the capacity of a national network of organizations to connect farmworkers to COVID-19 education and vaccinations in 20 states through training and resource sharing. The partnership funded 194 network member staff, trained 1130 individuals, and supported COVID-19 outreach to more than 600 000 farmworkers. (Am J Public Health. 2023;113(2):166–169. https://doi.org/10.2105/AJPH.2022.307159)

Farmworkers were considered to be essential during the COVID-19 pandemic, but they experienced numerous inequities throughout the different pandemic phases.^1–5 The 2.5 million US farmworkers are primarily immigrants, with more than two thirds born outside of the United States and half lacking authorization to work in the country.^6,7 Farmworkers have been found to have a four times higher incidence of COVID-19 infection than nonfarmworkers.⁴ Such health disparities are associated with vulnerabilities including crowded housing, lack of paid time off, limited access to health care, ineligibility for most federal public benefits, and an elevated prevalence of certain health risk factors for severe COVID-19 symptoms (e.g., diabetes).^8–10

The ill-equipped public health infrastructure in the rural United States exacerbated existing disparities during the pandemic.¹¹ Many community-based organizations around the country quickly stepped up to meet the needs of farmworkers, but they often had limited capacity and resources to address needs. The purpose of this article is to describe the initial impact of the development of a national network focused on protecting farmworkers’ health during the pandemic.

INTERVENTION AND IMPLEMENTATION

To help address public health infrastructure gaps among farmworkers, the Centers for Disease Control and Prevention (CDC) established a partnership with and provided $7.8 million in funding to the National Center for Farmworker Health (NCFH). NCFH established a national network of farmworker-serving organizations to guide and implement the project. The partnership provided COVID-19 prevention guidance to farmworker families and emphasized building the capacity of farmworker-serving organizations to conduct COVID-19-related outreach and education and support vaccination distribution.

Project implementation was guided by an advisory council that included farmworkers, employers, researchers, and organizational representatives. Twenty members were selected on the basis of multiple factors to ensure diversity in geography, areas of expertise, and organizational missions. Ten of the members were also funded network subrecipients. The council provided monthly guidance on project priorities. CDC staff provided technical support and facilitated coordination with the CDC COVID-19 response.

The primary strategy was to enhance the organizational capacity of the network partners through training, resources, and funding. The subcontract language was flexible so that organizations could implement local strategies using their own expertise. On the basis of needs identified from capacity assessments, NCFH provided responsive training and technical assistance (TA) sessions, disseminated resources, and supported the development of new partnerships.

PLACE, TIME, AND PERSONS

The project, which was national in scope and implemented from October 2020 through September 2021, focused on geographic areas with high concentrations of farmworkers. Network partners were located in 20 states (Figure 1).

FIGURE 1—

Location of 41 Farmworker-Serving Network Organizations That Received Technical Assistance as Part of the CDC/NCFH Partnership to Protect and Support Farmworkers During the COVID-19 Pandemic, October 2020–September 2021

Note. CDC = Centers for Disease Control and Prevention; NCFH = National Center for Farmworker Health.

There were 54 network partners formally involved in the project. Forty-one organizations were formally subcontracted to provide COVID-19 outreach, education, mitigation, and vaccination support. Two of the organizations were agricultural employers, and the remaining 39 were providers of social, health, or legal services to farmworkers.

PURPOSE

The partnership was established with the following objectives: (1) enhance the capacity of farmworker-serving organizations to connect farmworkers and their families to COVID-19 education, resources, and vaccines and (2) build a network to increase collaboration among farmworker-serving organizations and other entities as a means of enhancing the impact and sustainability of their efforts.

EVALUATION AND ADVERSE EFFECTS

To assess the initial impact of the project, network organizations regularly reported quantitative data on their activities to NCFH. NCFH collected data via capacity assessments, virtual meetings, telephone interviews, and surveys regarding needs and experiences during the project.

Advisory Council

Ninety percent of members felt that their voice was always heard during meetings and acted on by NCFH. Council member input was often actionable; for example, members recommended supporting local vaccination efforts over national campaigns, and when NCFH received additional funds for the project, support for local vaccination efforts was prioritized.

Capacity Assessment and Training

Key needs identified in organizational capacity assessments included themes such as outreach with vaccine-hesitant farmworkers, social media usage, and virus variants, among others. NCFH directly connected organizations that needed expertise in a certain area with organizations that possessed such expertise.

In response to broadly identified information or capacity needs, NCFH hosted 11 virtual English- and Spanish-language training sessions for 1130 participants from farmworker-serving organizations. The overall objective of the training was to increase outreach and public health knowledge while building on participants’ existing knowledge of their local communities. Training evaluations indicated increases in knowledge: 65% of the participants reported a high or extremely high level of knowledge gained, and 89% were satisfied or extremely satisfied with the training they received.

Staff and Outreach Resources

Project funds supported 194 part-time and full-time outreach and programmatic staff. Organizations reported reaching 601 956 farmworkers and family members with COVID-19 education through telephonic, video, or face-to-face methods (some individuals may have received more than one service) and assisted in providing at least one dose of a COVID-19 vaccine to more than 63 290 farmworkers and family members during the project period. Organizations also were given multilingual health education materials and face masks, gloves, and hand sanitizer to distribute to farmworkers (Table 1).

TABLE 1—

Summary of Project Outcomes Resulting From the CDC/NCFH Network Partnership to Protect and Support Farmworkers During the COVID-19 Pandemic, October 2020–September 2021

Outcomea	No.
Capacity-building activities
Full- or part-time staff supported through network funds	194
Network training participants	1 130
Technical assistance support recipients	1 107
Farmworker outreach activities
Farmworkers and family members who received at least one dose of a COVID-19 vaccine	63 290
Farmworkers and family members reached with COVID-19 prevention or vaccine education (in person, via telephone, or through video calls)b	601 956
Facemasks, gloves, hand sanitizer items distributed to farmworkers	568 320
Farmworkers who received COVID-19 testing referrals and support	46 389
Farmworkers who received food distribution or isolation and quarantine support	10 016

Note. CDC = Centers for Disease Control and Prevention; NCFH = National Center for Farmworker Health.

^a Some individuals may have received more than one service. Because of differences in the timeline to complete subcontracts, six organizations reported metrics from November 2020 through September 2021 and 35 organizations reported metrics from May 2021 through September 2021. The metrics reported here reflect all metrics reported from November 2020 through September 2021.

^b Two organizations were able to report only all farmworkers educated by their organization and not the number reached specifically through activities undertaken pursuant to the CDC/NCFH cooperative agreement and the NCFH subcontracts.

Technical Assistance

In addition to group training, NCFH provided TA support to organizations to build their capacity and increase access to public health resources. Types of TA included identifying health education resources appropriate for farmworkers, presenting at workshops, exchanging ideas among partners, and offering support in using outreach technologies. A total of 1017 individuals took part in nearly 230 TA interactions focused on COVID-19.

Network Collaborations

Supporting collaborations among farmworker-serving organizations, employers and industry associations, health departments, and CDC programs was another major focus of building capacity. Connecting new partners was facilitated via local network projects, TA interactions, and hosting of network calls to exchange ideas, build skills, and learn about promising practices around the country. NCFH hosted a total of eight network calls in English and Spanish, and an average of 22 participants attended each call. This exchange of ideas was especially critical for innovation and problem solving when organizations were dealing with widespread outbreaks of COVID-19 and during earlier phases of vaccine distribution.

SUSTAINABILITY

Network members indicated that partnership resources were essential to provide COVID-19 education to farmworkers and support vaccination efforts. The primary challenges in implementing these efforts were rapidly evolving public health strategies and limited capacity of local organizations as a result of other projects or staff shortages. Sustaining the staffing levels and resources used to maintain the network is projected to cost $4 million to reach approximately 600 000 farmworkers and their families annually. Continuing the network would facilitate ongoing outreach and education on a variety of health topics and a more rapid response to future public health emergencies.

PUBLIC HEALTH SIGNIFICANCE

We concluded that local farmworker-serving organizations played a critical role in implementing public health activities during the pandemic through disseminating public health information and guidance, bringing local issues among farmworkers to the attention of public health officials, and delivering health services and education to farmworkers. A national partnership focused on allowing local organizations to act on their expertise may be useful in efforts to address other health needs of farmworkers and reduce health disparities faced by this critically important population.