Ebola and community health worker services in Kenema District, Sierra Leone: please mind the gap!
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Setting: All community health workers (CHWs) in rural Kenema District, Sierra Leone. Objective: CHW programmes provide basic health services to fill gaps in human health resources. We compared trends in the reporting and management of childhood malaria, diarrhoea and pneumonia by CHWs before, during and after the Ebola outbreak (2014–2016). Design: Retrospective cross-sectional study using programme data. Results: CHW reporting increased from 59% pre-outbreak to 95% during the outbreak ( P < 0.001), and was sustained at 98% post-outbreak. CHWs stopped using rapid diagnostic tests for malaria mid-outbreak, and their use had not resumed post-outbreak. The average monthly number of presumptive treatments for malaria increased from 2931 pre-outbreak to 5013 during and 5331 post-outbreak ( P < 0.001). The average number of monthly treatments for diarrhoea and pneumonia decreased from respectively 1063 and 511 pre-outbreak to 547 and 352 during the outbreak ( P = 0.01 and P = 0.04). Post-outbreak pneumonia treatments increased (mean 1126 compared to pre-outbreak, P = 0.003), and treatments for diarrhoea returned to pre-outbreak levels ( P = 0.2). Conclusion: The CHW programme demonstrated vulnerability, but also resilience, during and in the early period after the Ebola outbreak. Investment in CHWs is required to strengthen the health care system, as they can cover pre-existing gaps in facility-based health care and those created by outbreaks.
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Until CHW training and remuneration are absorbed by the MoHS and more broadly integrated into the existing health system, the sustainability of the CHW programme and the corresponding community services are at risk.
“For example, as shown by international experience, until CHW training and remuneration are absorbed by the MoHS and more broadly integrated into the existing health system, the sustainability of the programme and the corresponding community services are at risk [8, 17, 40].”
From Health sector fragmentation: three examples from Sierra Leone (2019) · cites this paper as [40]
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- Authors
- Vandi, M. A., van Griensven, J., Chan, A. K., Kargbo, B., Kandeh, J. N., Alpha, K. S., Sheriff, A. A., Momoh, K. S. B., Gamanga, A., Najjemba, R., & Mishra, S.
- Affiliations
- Ministry of Health and Sanitation (SL)
- University of Toronto (CA)
- International Rescue Committee (US)
- European Organization for Nuclear Research (CH)
- St. Michael's Hospital (CA)
- Corresponding author
- Vandi, M. A.
- Venue
- Public Health Action
- Published
- 2017-06
- Volume
- 7
- Issue
- Supplement 1
- Pages
- S55-S61
- ISSN
- 2220-8372 (ISSN-L)
- PMC
- PMC5515565
- OpenAlex
- W2737180837
- Cited by
- 25
- References
- 12
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 5 · 2020: 7 · 2019: 4 · 2017: 1
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Public Health Action (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
- Keywords
- community health workers, Ebola outbreak, pediatric malaria, diarrhea, pneumonia, health care delivery, rapid diagnostic tests, presumptive treatment, health system resilience, rural health care
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