Liberia’s National Community Health Worker Programs

By: Julia Rogers, Harriet Napier, and Mallika Raghavan

The health landscape in Liberia emphasizes preventative and curative services. Community Health Assistants surveil emerging challenges to managing issues related to communicable and non-communicable diseases, maternal and child health, family planning, and other health service needs experienced within local communities. They work in tandem with Community Health Service Supervisors to serve those living farther than 5 kilometers from health facilities. In a three-year period, Community Health Assistants addressed over one million requests for support.

Background

Liberia’s first seven-year civil war from 1989 to 1996 left its health infrastructure devastated. Less than a decade later, the 2014-5 Ebola virus outbreak hit the country, further overwhelming already weakened public health systems. Because of its chronic shortage of higher-level trained workers, poor roads, and weak health infrastructure, its population of 4.7 million people has depended on Community Health Volunteers for many basic health services. As part of the 2016 revised National Community Health Services Strategic Plan, a new cadre of salaried community health workers called Community Health Assistants (CHAs) was created to upgrade the community-level workforce.

Implementation

By late 2019, 3,761 CHAs and their supervisors, Community Health Service Supervisors (CHSSs) had been deployed to serve communities living further than 5 kilometers from a health facility. The policy objective calls for 1 CHA for every 40-60 households or 350 people. At full implementation, the country anticipates 4,000 CHAs and 400 CHSSs.

Training

CHA training consists of four modules, each of which is 8-11 days in length, for a total of

approximately two months of formal training. Each module is separated by several weeks during which time the CHA trainee can practice the new skills acquired with support and assessment by their supervisor, the Community Health Services Supervisor.

Roles/responsibilities

CHAs provide a broad range of preventive and curative services, including surveillance for disease outbreaks, identification of pregnant women and referral for antenatal care and delivery at a facility, distribution of family planning commodities, and management of uncomplicated cases of childhood pneumonia, diarrhea and malaria using the Integrated Community Case Management (iCCM) protocol.

Incentives and remuneration

CHAs receive US$ 70 per month as an incentive.

Supervision

Each CHSS supervises approximately 10 CHAs. The CHSS is a new cadre. Each CHSS has already been trained as a health worker (nurse, midwife or physician’s assistant) and receives an additional 4 weeks of training. Supervision occurs both in the field and during monthly meetings at the nearest health facility.

Impact

Because of the recent implementation of the program, no impact assessments have yet been carried out. However, between 1 July 2016 and 31 October 2019 CHAs provided more than 1 million important services in homes – management of childhood illness and provision of antenatal and postnatal care.

Author Affiliations

• Julia Rogers is a PhD Candidate in Epidemiology at University of Washington, Seattle, Washington, USA
• Harriet Napier is a Program Manager in Community Case Management at Clinton Health Access Initiative, Inc., New York, New York, USA
• Mallika Raghavan is a Director of Country Engagement at Last Mile Health, New York, New York, USA

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