Volunteer health workers ensure lifesaving health services and information get to remote areas

Health service delivery to rural communities remains a challenge in Sierra Leone.

Arwen Kidd
Community Health Worker Musa B. Jawara poses with just a few of the children who have benefited from routine immunization campaigns
UNICEF Sierra Leone/2019/Kidd
15 January 2020

Hurgon, Sierra Leone - The community of Hurgon is located in Sierra Leone’s Falaba District – formerly part of Koinadugu District, in the country’s Northern Province. With a population of approximately 200 people divided between about 50 or 60 households, the community relies largely on farming activities to support itself on a day to day basis. Rice, groundnuts, and maize all grow in the fields surrounding the town, and some residents are lucky enough to raise a few cattle, which can be sold for a profit in other areas of the country.

In Hurgon itself, there are no schools, and no shops. The nearest such structures are located in the town of Musaia – two miles away, down a lone dirt road. With no motorcycles or taxis (which are usually the main forms of public transportation), residents must walk if they wish to go to market, attend class, or visit the small Musaia Community Health Centre that serves the surrounding area.

At age 25, Musa B. Jawara has lived in Hurgon all his life. Having done so, he understands well the challenges of living in the small, remote community – with limited access to health care, and information about health care, he says, being at the top of the list.

“We have a lot of health challenges here,” he explains, including frequent cases of malaria, pneumonia, and diarrhoea. “Many of our people still believe in using traditional medicine. They are suspicious about any other treatments, and when they see new nurses or doctors that they don’t know, they can sometimes be scared.”

These, Musa explains, are just some of the reasons that his role as a Community Health Worker in Hurgon is so important. The community knows him and so trusts him when he tells them about treatments that are available, or immunisations that can help protect their children against illness – referred to as “marklets” in the local language.  Often, Musa says, he ends up accompanying other community members to the Musaia Health Centre, walking there with them to make sure they understand the processes, and receive the care they need.

Musa Jawara walking through his community of Hurgon, where he has served as a Community Health Worker for the past three years.
UNICEF Sierra Leone/2019/Kidd
Musa Jawara walking through his community of Hurgon, where he has served as a Community Health Worker for the past three years.

Musa is just one of over 14,500 volunteer Community Health Workers or “CHWs” active across Sierra Leone. With the country facing a chronic shortage of skilled health workers (in 2015, it was estimated that Sierra Leone had a total of only 4,775 skilled health workers, including doctors, midwives, and registered nurses to serve a population of over 7.1 million people), these CHWs play an important role in helping to fill the gap. Trained and supervised by the Government of Sierra Leone’s District Health Management Teams, with support from UNICEF Sierra Leone and funding from the GAVI Alliance, they fulfill a range of duties: educating neighbours about the importance of immunizations, tracking the health and progress of pregnant mothers, screening for illness and malnutrition among children under-5, and testing for and treating malaria when cases are suspected. For community members in need of more specialized care, CHWs are also in charge of referring complicated cases to nearby health facilities, and often step in to help ensure the patients get there safely.

“Before I was a Community Health Worker, I saw so many challenges about health in my community. I saw children who were sick, and staying sick because their parents were only using the traditional herbs to treat them, which was not enough.”

Musa Jawara, Community Health Worker

“That was when I decided on my own – there is sickness in my community, and I want to help. So, I went to the nurses in Musaia and asked them, ‘How can I help?’ They started to teach me, and we went from there.”

Musa says he acted as an informal ‘health volunteer’ in his community for almost three years before being invited to become an official Community Health Worker through the government’s program. It was this opportunity, he says, that allowed him to receive additional training, and qualify for a small stipend that enables him to travel to other nearby communities, to share information with even more residents – ensuring that they too know about upcoming immunization opportunities and understand the health services available to them.

“Access to health services in the remote areas of Sierra Leone remains a challenge because of distances between communities and the nearest healthy facility and also because of pervasive social norms and beliefs,” says UNICEF Representative, Dr. Hamid El-Bashir Ibrahim. “The commitment and dedication of Community Health Workers is critical in the realisation of our goal of ‘leaving no-one behind’ in accessing the best health care and relevant information to maintain healthy habits.”

As for Musa, he says he will carry on with this work as long as he is able.

“I am a farmer by trade,” Musa says, “and I will continue to be a farmer. But I do not like to see so much sickness around me. So even though it takes up a lot of time, I am glad I am able to do this additional health work, to help support my community.”