Community Health Workers: the backbone to improving health in Freetown

A team of Community health workers (CHWs) in Dwarzack community, Freetown. Photographer: Michael Duff
A team of Community health workers (CHWs) in Dwarzack community, Freetown. Photographer: Michael Duff

Our National Health Coordinator in Sierra Leone, Adèle Fox, reflects on Concern’s Child Survival Project – a programme that focused on reducing maternal and child deaths.

I am proud to say that I’ve been part of a five and a half year Child Survival project which has just ended here in Sierra Leone. This country sees some of the highest rates of maternal and child deaths in the world. Most of these deaths - which are usually related to complications in pregnancy and childbirth, new-born conditions (such as complications of premature birth or infections), and childhood diseases, and are rare in the developed world - could be prevented.

Our Child Survival project aimed to reduce these alarming statistics in the slums of Freetown, and we made good progress in doing this. A central part of the project was training 1300 voluntary Community Health Workers (CHWs) to go door to door and deliver messages encouraging mothers to take simple preventative actions that can save lives such as: having regular antenatal checks, using a mosquito net, purifying their water, using family planning to space their children, and seeking medical treatment when their children are sick The CHWs were also trained in when and how to refer sick children to the health facility. These people were at the heart of the programme, gaining the trust of their neighbours and slowly helping them to change things for the better. One mother told us:

I had ignored the recommendations to give my child only breast milk from the nurses at the clinic, but I took the advice from the CHW because I could easily relate to her, more than to the nurses. The CHW would talk with me more often, and also she is my neighbour. I am glad that she advised me to do that because my child is strong and has not been sick”.

With time comes change

In fact, the CHWs made 226,228 household visits and 54,088 referrals over the course of the project. The community appreciated this one-to-one contact hugely and felt the health workers had shown them how to take care of their children and keep them healthy.

Community health worker Nabie Kargbo explains the importance of clean water to Fullah Sesay in Dwarzack community, Freetown Photographer: Michael Duff
Community health worker Nabie Kargbo explains the importance of clean water to Fullah Sesay in Dwarzack community, Freetown Photographer: Michael Duff

However, changing people’s behaviour was not always an easy task. One Community Health Worker told us:

There are some stubborn people who ask what proves we are working with Concern or who are convinced we are being paid and don’t want to listen to us. They accuse us of being quack doctors. But we were taught to have patience. You have to accept the situation as it is and make an agreement to visit another time. With time they will listen to you. If you force the message it won’t go through.

The determination of many of these volunteers has contributed to more pregnant women receiving the recommended four antenatal care visits (from 47%-68%); more women giving birth at a health facility (74%-95%); more women using contraceptives (38%-50%); and more babies being breastfed within an hour of birth (52%-70%), among many more successes.

Communityhealth worker Fatmata Conteh demonstrates correct hand washing practices to people in Dwarzack community, Freetown. Photographer: Michael Duff
Communityhealth worker Fatmata Conteh demonstrates correct hand washing practices to people in Dwarzack community, Freetown. Photographer: Michael Duff

In it together

But these Community Health Workers did not work alone. They were supported by community leaders who supervised their work, helped to reinforce messages, and took action in their communities based on what the health workers reported back to them. As well as doing this work for the love of their community, this support was so highly valued that it motivated many of the CHWs to continue working as volunteers for several years.   

Even though our project has come to an end, fortunately the Government of Sierra Leone has recognised the central role that CHWs play in keeping communities healthy, and are now rolling out a new national CHW programme by which Community Health Workers are officially regarded as part of the health workforce.

To see more about this project, watch this video:

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