By: Meredith Dyson, Elizabeth Musa, Harriet Napier, and Jess Gergen
The West Africa Ebola Outbreak created an opportunity for Sierra Leone to restructure and relaunch their national CHW program after years of segmented community-based programs. The current program structure lends itself to a part-time, daily work schedule whereupon each CHW provides a diverse set of care services for children and adult men and women. The recency of the CHW program relaunch represents an opportunity to evaluate current impacts of the workforce on Sierra Leone population health.
Sierra Leone has a long history of “siloed” vertical community-based health programs. Its first National Community Health Worker (CHW) Policy was launched in 2012, providing an umbrella under which some of these previously established programs moved toward harmonization. After 3 years of experience and many lessons learned during the West Africa Ebola Outbreak (2014–2016), the National CHW Policy was revised in 2015–2016 and relaunched in 2017.
The National CHW Program is managed through the Directorate of Primary Health Care (DPHC) within the Ministry of Health and Sanitation (MOHS). A CHW Hub (established in 2015 within the DPHC) manages the program implementation at the central/national level, while some decision-making and implementation is decentralized to district health management teams (DHMTs) in all 14 districts across the country. Many non- governmental organization (NGO) partners also support the implementation of the National CHW Program. Approximately 13,000 CHWs and 1,300 Peer Supervisors have been trained and deployed throughout every district of the country – in remote rural, peri-urban, and urban communities.
Sierra Leone’s CHW Program focuses on Integrated Community Case Management of Childhood Illness (iCCM); reproductive, maternal, newborn, and child health; and community-based disease surveillance. CHWs conduct quarterly household visits to all households within their communities, during which they promote preventive behaviors and collect essential demographic information. CHWs provide counseling to both men and women on the benefits of birth spacing, and they are equipped to distribute condoms and oral contraceptive pill refills. They conduct community surveillance and reporting for prevalent epidemic-prone illnesses and health conditions, report all births, report all maternal and child deaths, and provide referral linkages to the nearest health facility for complicated conditions and conditions outside of their own scope of work. CHWs are expected to work 4-5 hours per day, 5 days a week.
The curriculum consists of 24 days of classroom training broken up into three modules, with approximately a month of field practice afterwards. Peer Supervisors also complete a fourth module (of 4 days) focused on supervision, coaching, and mentoring skills as well as on data collection and reporting. On-the-job coaching, in-service training, and mentoring are ongoing.
Peer Supervisors were formally introduced in 2016. Peer Supervisors are full-time supervisors. They do not provide CHW services in addition to their supervisory roles. Peer Supervisor selection prioritizes those who have previously served as a CHW and have been identified as high-performing leaders among the group of CHWs linked to a Peripheral Health Unit. In addition to data collection and reporting, their role focuses on coaching, mentorship, and on-the-job training of the CHWs within their catchment area.
Incentives and remuneration
CHWs receive an incentive of Le 100,000 (approximately US$ 13.50) per month plus an additional small allotment for travel expenses to attend monthly meetings and to cover communication costs.
Since the program has just been rolled out, there is not yet any evidence of impact.