Bringing lifesaving services to mother and baby in rural Sierra Leone

On the frontlines, far from doctors, nurses and health care facilities, community health workers are the real heroes

By Harriet Mason
Nancy Tucker, community health worker
UNICEF Sierra Leone/2017/Phelps
29 June 2017

FREETOWN, Sierra Leone, 29 June 2017 – It’s Tuesday evening, and Nancy Tucker has finished tending her plot of potatoes and okra. She packs her tools and heads back to the village. Once there, she’ll see to the community’s latest crop – of newborn babies. Nancy has been serving her community as a volunteer community health worker since 2008.  

Access to essential services

Without access to health services, children risk dying from such common preventable illnesses as malaria, pneumonia and diarrhoea. Access is what community health workers like Nancy can provide. They are the heroes on the frontlines, reaching families who live far from doctors, nurses and health care facilities with basic health advice and treatment.

And in a country with some of the world’s highest rates of maternal and child mortality, these services matter.

One service Nancy provides is to work with pregnant women to manage their health and the health of the babies they are expecting. “I counsel pregnant women in my village 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, convince them to exclusively breastfeed their babies for six months after they give birth and educate them on good hygiene practices.”

In fact, because of Nancy’s outreach, delivering babies in any place other than a health facility is a thing of the past.

UNICEF Sierra Leone/2017/Phelps

Community health worker Nancy Tucker talks with mother Tenneh Mansaray, holding her 9-day-old son Manso Turay, in Bambaya village, Kono district.

‘Aunty’ Nancy’s rounds

Today, the first stop on Nancy’s rounds is Tenneh Mansaray’s home, to visit the mother’s newest baby, 9-day-old son Manso Turay. Tenneh tells us she has made antenatal care a habit and in fact gave birth to four of her children at the Bombordu health facility because of Nancy’s advice.

“She made me understand the benefits of going to a health centre. I didn’t mind walking four miles to get to the health centre because I know that the care I receive there I can’t get in my village,” she says. “I and my babies are always okay when I give birth, and they hardly get sick because I take all the vaccines during my pregnancies and also get them vaccinated.”

Another resident of the village confirms the effect Nancy has had on the community’s health. “I am happy about the way Aunty Nancy does her job,” says Tamba Ansumana. “Our son is 5 months old now, but Nancy keeps checking on us to ensure he is exclusively breastfed until he is 6 months old, and also sleeping under a bed net. He is very healthy and has never been sick since he was born because we are following the advice she gave us,” he adds.

UNICEF Sierra Leone/2017/Phelps

Community health worker Nancy Tucker holds 5-month-old Samuel Ansumana in Bambaya village, Kono district.

A mandate recognized by government

Indeed, the programme has become so critical to community health that the government now recognizes the community health workers’ mandate as part of the country’s primary health care system. Sierra Leone launched a revised national policy on community health workers in February that expands the scope of their work. Now, the workers have access to additional training, and will start receiving a monthly stipend.

And what more will the workers do? “[They] are being trained to improve their skills to deliver lifesaving services including integrated community case management and maternal, newborn and child health to their communities,” says Thomas Hazely, Health Programme Manager at the International Rescue Committee, UNICEF’s implementing partner for the project in Kono district.

Tonight, as Nancy heads back home at the end of her round of home visitations, she says she thinks of herself as a lifesaver. “I am very proud about the work I do caring for women and children.”


The International Rescue Committee has been providing technical support to the Kono District Health Management Team and has helped train and position 951 health workers like Nancy across all chiefdoms in the district. Through UNICEF, supported by funding from UK aid from the British people, these workers continue to provide maternal, newborn and child health services and to promote improved nutrition, hygiene and waste management, and family planning in the district.

Beyond Kono, Sierra Leone is implementing the revised national policy through a network of some 15,000 community health workers and peer supervisors across all districts. UNICEF, with UK aid funding, is supporting the implementation in Bombali, Kambia and Bonthe districts with a network of 4,060 community health workers and 406 peer supervisors. In addition, with this funding, UNICEF is equipping the 15,000 community health workers and peer supervisors with equipment and supplies to be able to deliver better in their new expanded role. These supplies includes training materials, job aides and tools, rain gear, torch lights, t-shirts, back packs and acute respiratory infections timers.