BRIDGING THE HUMAN RESOURCES GAP: INTEGRATING COMMUNITY HEALTH WORKERS INTO SIERRA LEONE’S HEALTH CARE SYSTEM

Abstract

Sierra Leone faces a huge shortage of trained health workers. Deficiencies are most acute for the highest skilled professionals: physicians and nurses. Compounding these deficiencies, the nation suffers from a maldistribution of staff between rural and urban areas, as well as the private and public sectors. Indeed, compared to the private health sector, the public sector suffers the most acute deficiencies and will be the main concern of this thesis. The effects of staff shortages on health outcomes are well documented. The lack of manpower overburdens health professionals, increasing the likelihood of lapses in treatment or medical decision-making. Health outcomes have been positively correlated to the availability of staff. Moreover, some of the fundamental elements of the Sierra Leonean health policy require trained professionals to implement safely and effectively. The causes of this crisis are complex and dynamic. Historical factors precipitated the exodus of health professionals, notably the civil war lasting from 1991-2002, but today low pay; inadequate monitoring, supervisory, and support structures; poor career development options; lack of incentives (especially for hard-to-reach areas); and cumbersome and bureaucratic recruitment processes represent key factors The Sierra Leonean government has identified human resources for health to be one of the health sectors greatest priorities, and to that end, proposed additional strategic objectives, actions, and targets. These include rural allowances, creation of auxiliary positions, and temporary service from foreign doctors. More policies lie in the pipeline, both to strengthen existing measures and to create and implement new ones. Most recently, the government has indicated renewed interest in strengthening Community Health Worker (CHW) programs in response to the severe manpower shortage. CHWs have been used in Sierra Leone and other countries (particularly those that are lowincome), to render basic health services to the communities from which they come. While concept of Community Health Workers has been around for at least 50 years, but Sierra Leone has only in the past few years drawn up policies and guidelines around the definition of and training of Community Health Workers. This policy move signals the government’s recognition that Community Health Workers may play a vital role within the health sector; relative to training and retaining doctors and nurses, building a viable CHW corps takes less time and fewer resources. In addition, this policy shift indicates the government’s awareness that the public sector itself is uniquely positioned and thus has a responsibility to provide support to scale up community level health intervention. This thesis argues both that CHW programs deserve the renewed attention, and that the public sector may take specific steps to support these programs. Among health interventions to address human resource gaps, CHW programs hold some of the greatest potential for low-cost, high-impact results. At the same time, a review of CHW programs in Sierra Leone and other regions indicates that not all CHW programs are successful, and those that are require institutional support in order to have sustainable, positive effects. By focusing efforts on strengthening the country’s CHW programs, the Sierra Leonean government will demonstrate that community participation remains an integral part of the state’s responsibility over health care access and delivery.