Abstract
Introduction: Community health workers (CHWs) play an integral role in Sierra Leone's health systems strengthening efforts. Our goal was to understand CHWs' experiences of providing immunization and malaria prevention services in urban settings and explore opportunities to optimize their contributions to these services.Methods: In 2018, we conducted an exploratory qualitative assessment in the Western Area Urban district, which covers most of the capital city of Freetown. We purposively selected diverse health facilities (i.e., type, ownership, setting) and recruited CHWs through their supervisors. We conducted eight focus group discussions (FGD) with CHWs, which were audio-recorded. The topics explored included participants' background, responsibilities and priorities of urban CHWs, sources of motivation at work, barriers to CHWs' immunization and malaria prevention activities, and strategies used to address these barriers. The local research team transcribed and translated FGDs into English; then we used qualitative content analysis to identify themes.Results: Four themes emerged from the qualitative content analysis: (1) pride, compassion, recognition, and personal benefits are important motivating factors to keep working as CHWs; (2) diverse health responsibilities and competing priorities result in overburdening of CHWs; (3) health system- and community-level barriers negatively affect CHWs' activities and motivation; (4) CHWs use context-specific strategies to address challenges in their work but require further support.Conclusion: Focused support for CHWs is needed to optimize their contributions to immunization and malaria prevention activities. Such interventions should be coupled with systems-level efforts to address the structural barriers that negatively affect CHWs' overall work and motivation, such as the shortage of work supplies and the lack of promised financial support.
Highlights
Community health workers (CHWs) play an integral role in Sierra Leone’s health systems strengthening efforts
The Ebola epidemic’s impact on Sierra Leone’s vaccine-preventable diseases (VPDs) prevention activities is evidenced by an increase in the incidence of confirmed measles, which remained higher than pre-epidemic levels through 2017 [2]
As Sierra Leone sought to rebuild trust and confidence in child health services after the Ebola epidemic ended, we aimed to gain a qualitative understanding of the role and experiences of CHWs in promoting immunization and malaria prevention services in an urban context
Summary
Community health workers (CHWs) play an integral role in Sierra Leone’s health systems strengthening efforts. Sierra Leone continues to have one of the highest mortality rates among infants and children under 5 years of age (under-five) globally, some progress has been made. Vaccine-preventable diseases (VPDs) such as measles and other preventable diseases such as endemic malaria pose serious challenges to the country’s fragile health system while it continues to recover from 2014 to 2016 Ebola epidemic [2, 3]. Maternal and child health (MCH) services, including immunization and malaria prevention services, were severely disrupted during the epidemic [4] due in part to bi-directional fear and stigmatization associated with Ebola among healthcare workers and patients, as well as resource constraints in the health system [5]. Estimates from an urban district in Sierra Leone indicate suboptimal vaccination coverage, with reported MCV1 coverage of 77% as of 2019 [8]
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