Community Health Workers striving to ensure continuity of health service delivery during COVID-19

An effort to keep health service delivery going in Sierra Leone

Harriet Mason
A Community Health Worker sensitizes a family in Hastings about COVID-19 preventive measures
UNICEF Sierra Leone/2021/Mason
22 February 2021

Hastings, Sierra Leone – It’s a Monday evening, and Adama Kamara has closed her small-scale grocery business for the day. She packs her items, gets a fresh mask on and heads out to visit the pregnant women and children under the age of five in New Site community. Adama has been serving as a volunteer Community Health Worker (CHW) since 2017.

Today, her first stop is the home of two-year-old Zainab Jalloh, to check on her and find out if her family still observes the COVID-19 preventive measures she sensitized them about during her last visit.

When Sierra Leone recorded its first COVID-19 case in March 2020, it stirred a lot of fear in people, including among health workers as there was little knowledge about the disease, while many channels of information were propagating rumours and untruths. This posed stumbling blocks to health service delivery, as people’s trust in the health system was undermined.

“When Corona broke out here, people became reluctant to go to health facilities for fear of being infected” says Adama, as she recounts her experiences of working in the wake of the pandemic.

“I was also initially scared of catching the disease and spreading it while carrying out my duties because I didn’t know much about it,” she adds.

Thanks to knowledge gained from a recent training on Interim Guidance on Community Based Reproductive, Maternal, Newborn, Child, and Adolescent Health Care during COVID-19, health workers keep making efforts to ensure continuity of health service delivery in the context of COVID-19 pandemic.

“The training has equipped us to continue providing our services in a safe manner and also guide our communities on how to protect themselves and others from the virus.”

Adama Kamara
Adama Kamara, a Community Health Worker in Hastings, western Sierra Leone, heads out to do home visits.
UNICEF Sierra Leone/2021/Mason
Adama Kamara, a Community Health Worker in Hastings, western Sierra Leone, heads out to do home visits.

In normal times, Adama would take measurements of babies' arms using the Mid-Upper Arm Circumference (MUAC) tape, to determine their nutritional statuses. She also found pleasure is joyfully carrying the babies on her lap and playing with them. She would also test sick children for malaria with a rapid diagnostic test kit and treated them if the tests are positive.

Due to the pandemic, this physical contact is being avoided and Adama now guides caregivers to do the measurements and while tests for malaria are now only being done at the health facilities.

“Since we were ordered to stop running malaria tests on children, we have been referring caregivers to the health center for diagnosis. The caregivers also the ones who are now checking the nutritional statuses of children using the measuring tape,” says Adama, as she directs Aminata on the use of the MUAC tape, while carefully observing social distancing.

Adama directs Aminata as she checks the nutritional status of two-year-old Zainab
UNICEF Sierra Leone/2021/Mason
Adama directs Aminata as she checks the nutritional status of two-year-old Zainab

Aminata, Zainab’s grandmother tells us she has always taken Zainab for medical attention the few times she has fallen ill.  She says that through Adama’s advice and guidance, she has ensured that Zainab gets regular check-ups at the community health centre.

According to Aminata, Adama helped her understand the benefits of visiting the health centre when necessary. “Zainab hardly gets sick because she has taken all her prescribed vaccines. Even during this COVID-19 pandemic, I still take her to the health center for check-ups and treatment because I know that she receives is vital for her wellbeing,” she says.

Another duty of CHWs is to provide guidance to pregnant women to manage their health and that of the babies they are expecting. “I counsel pregnant women in my community about the importance of accessing antenatal care services at the health facility and also giving birth there,” she explains. “I advise them to take all their vaccines, eat well, practice good hygiene and exclusively breastfeed their babies for six months after they give birth.”

Adama chats with Umu Foday, a pregnant woman in her community
UNICEF Sierra Leone/2021/Mason
Adama chats with Umu Foday, a pregnant woman in her community

Thanks to Adama’s outreach during the precarious times of COVID-19, pregnant women in New Site community are steadily accessing health facilities for services which include antenatal classes and childbirth.

“The pregnant women still come for ante-natal and maternity services and bring the babies in after they give birth,” said Marvel Cole-Showers, a mid-wife at the Hastings Community Health Centre. According to Marvel, some 2,695 women accessed ante-natal services at the health center in 2020.

Umu Foday, a pregnant woman and mother of two young boys shares how thankful she is for Adama’s services. “I am happy that we have her here. She visits us regularly to ensure I sleep under a bad net, go for my antenatal sessions and eat well,” says Umu. “I have hardly had any problems with this pregnancy and I’m looking forward to giving birth at the health facility,” she adds.

As Adama heads back home at the end of her round of visitations for the day, she says she thinks of her work as lifesaving. “I am very proud that I am contributing to the fight against maternal and under five mortality in my country by helping children and their families stay healthy.”


UNICEF Sierra Leone would like to thank the Global Fund for its generous support which has enabled the Ministry of Health and Sanitation and UNICEF to strengthen health care delivery through the implementation of the CHW strategy, which is improving the health outcomes of children and women in Sierra Leone including during the COVID-19 pandemic.