Originally published in the fall 2018 newsletter of the Financing Alliance for Health.
Community health programs are being launched all across the world, and especially in sub-Saharan Africa. It is reminiscent of the post-Alma Ata period in the 1980s, but unfortunately, most of those programs performed sub-optimally due to poor design and under-investment.
Now at the 40 year anniversary of Alma Ata, the question on everyone’s minds is: are we going to repeat this unfortunate history? The Financing Alliance for Health (in collaboration with Last Mile Health, UNICEF) and Plan International teams have been working with the Government of Liberia to ensure that their ambitious national community health program thrives. We could barely contain our excitement, when we recently gathered a team for a site visit to Bomi County, one of the fifteen counties in Liberia, nestled in the north-western region.
We’ve heard some encouraging statistics, but numbers don’t always tell the whole truth. We had to see the work for ourselves.
The two-hour journey was somewhat harrowing: we waded through Monrovia and watched as the city gradually lit up to its daily activities before we hit the rough, un-tarmacked winding road, bumping in and out of large potholes that had filled with rain water. Some stretches of the road wound through the thick and muddy rain forest. This ride gave us tangible proof that distance and travel challenges really are a barrier to accessing health care. which is often “locked away” in cities and towns.
When we finally arrived at Bomi County hospital, we first paid a courtesy call to the community health department, met the leadership and informed them of our visit. The department was extremely well organized, with their supplies stocked up and the teams seemingly happy in their work serving the community.
Later that day we travelled about two kilometres from the hospital, and it was here that we finally met our everyday hero, the Community Health Assistant (CHA), Bob Kaifa. He beamed with excitement as he warmly welcomed us to his home. Following introductions, the FAH team took some time to chat with Bob. Here’s what he shared.
Mr. Bob Kaifa, tell me about your role as a Community Health Assistant (CHA)?
“I have always had a passion to help my community and being a CHA is very fulfilling for me. After graduating from high school, my parents could not raise fees for higher education for me but when I heard about this opportunity, I grabbed it with both hands! I attended training, got all the necessary materials and teaching aids I need as well as data registry and supplies from the Plan International team. Every week, my supervisor and I develop a plan for the week and I plan my time well to ensure I have reached all my community members who need me.
I conduct my house visits at specific timings, depending on the need. For example, if I need to also talk to the man of the home on certain health interventions, I will make my home visit in the evening after working hours. I also sometimes gather community members with similar needs for a health talk and demonstration: for example, women who have recently delivered. These teaching aids help me a lot. My greatest passion is to talk to young girls about how to prevent ‘big belly’.”
What do you mean by big belly?
After a long pause, he responds with a chuckle “they call me Mr Anti ‘Big-Belly’. Too many girls get pregnant at a very early age and this concerns me. You see (he points across to some two young girls in his compound), these are my sisters, barely 18 years of age and they have children. They have dropped out of school. If we are to end the cycle of poverty, we must stop ‘big-belly’! I spend a lot of time with young girls educating them on early pregnancy, the dangers and how to prevent it. I enjoy talking about the ‘big belly’!”
He is so passionate about this and from then, he was happy being called ‘’Mr Anti-Big-Belly’’ as most of young girls refer to him.
Indeed, teenage pregnancy is high in Liberia: a prevalence of 32%, coupled with the fact that 52.7% of the population is under 20 years of age. “Mr. Anti Big-Belly’s” efforts would go a long way in averting teenage pregnancy at the community level.
What are you most proud of so far?
“I am proud that people who live very far from the health facility in my community can have access to basic health services – malaria treatment, pneumonia diagnosis and quick referral to the hospital. I recently met one mother carrying her child to the hospital in a wheelbarrow. The child had pneumonia. I was so proud that she could recognize the signs by herself and take the right action of seeking care. I took them on my motorbike and we made it in time to the hospital. Beyond the joy of seeing my community members healthier, I have also made progress in my life and now I have been able to construct my own house! I am very proud of that.”
What message would you like to pass to the government on community health?
“First, I would like to appreciate the Government of Liberia for this CHA program. The whole of Liberia needs CHAs because our people should not die of pneumonia or malaria (or other diseases). My request is that the government trains many of us and employs us to serve our communities. There are many health challenges we must overcome – Malaria, pneumonia, ‘big belly’ and many others. Secondly, I am very grateful to our partner Plan International who believes in me and my fellow CHAs, to bring care close to our people.”
In Bob’s words, we hear the best of the new generation of community health workers in action, and there is so much that makes us optimistic. In partnership with multiple stakeholders, the Government of Liberia has launched the National Community Health Services Policy (2016-2021) that seeks to recruit, train and deploy 4,467 CHAs. So far 2,893 (65%) have been recruited.
Beyond the health benefits of extending care to the most vulnerable communities, Bob’s story tells us about how a paid, trained and supervised cadre of community health workers adds new opportunities for leadership, health care and economic growth for a community.
We at the Financing Alliance have known this, which motivated our $10 to $1 return on investment for such work, but we also know that there is a lot more work to be done to help these programs grow larger and stronger. In the meantime, everyday heroes like Bob help us rest a little more assured that we’re heading in the right direction.