CHW Central

A global resource for and about Community Health Workers

Elevating Country Voices: Sierra Leone

Originally published in the spring 2018 newsletter of the Financing Alliance for Health.

Mr. Alpha Bangura rushes into his office in Freetown, Sierra Leone glistening with sweat from the midday sun. As the National Community Health Director at the Ministry of Health and Sanitation, he spends a lot of his time traveling around Sierra Leone, or attending marathon meetings in the capital, to assure the newly hatched national CHW program (2016-2020) is running as planned. The Financing Alliance for Health (FAH) works closely with Mr. Alpha and his team, so we took some time out of our regular work day to reflect on the tremendous progress made so far in implementing this ambitious strategy.

Mr Alpha Bangura, why is community health a government priority and important to you?
“Over the years in Sierra Leone, a lot of emphasis had been placed on infrastructure as opposed to the community health system. Then, in 2014, Ebola struck!

This was an awakening moment for the government as the role of Community Health Workers (CHWs) became incredibly pivotal in combating the epidemic. Now scaling and strengthening a functioning community health system, with CHWs at its centre, is a government priority and a flagship program for the Ministry of Health. We believe CHWs are a cost-effective way of addressing the gaps in the health system as well as ensuring community-based surveillance to promote health and disease prevention.”

What are you most proud of so far?
“I am very happy that we have a strong plan for our community health system and that we have rolled out the initial pre-service training to about 15,000 CHWs.

We also have a costed program, financial gap analysis, an investment plan and an advocacy tool. These are very useful resources during discussions with stakeholders.

Thirdly, a community health reporting tool is now approved and incorporated into the District Health Information Systems (DHIS). This will be important for on-going performance management.”

What are the challenges you face and how have you overcome them?
“The greatest challenge is sustainability – while we are working towards mobilizing domestic resources and are exploring innovative financing approaches, currently the program is 100% donor funded.

Additionally, programatic capacity of our team members to drive a large-scale transformation in our health system has been a challenge. We are addressing this through capacity building focused on management and leadership skills (with the support of AMP Health).”

What lessons have you learnt that other countries could borrow a leaf from?
“The greatest and most important lesson is integration of the community health services with other health delivery platforms. How all health services fit together should be a consideration made at the time of system and strategy design. It requires all the directorates under primary healthcare and community health such as disease surveillance, reproductive health, nursing teams, Ministry of Finance etc to work together. Only this integrated design of the system allows for leveraging of resources and avoids duplication. It’s something we didn’t consider as strongly when designing the community health strategy.”