Despite the heat of Sierra Leone’s hottest month, James Koroma is doing the rounds of his home village visiting pregnant women, and postnatal mums and their new babies.
James is a community health worker (CHW), one of an ‘army’ of 15,000 volunteers in Sierra Leone that bring life-saving health, nutrition and other services closer to communities, often in hard to reach areas, living at considerable distance from health facilities.
“I am excited about being a CHW because it gives me opportunities to help save the lives of people in my community, especially women and children,” he said smiling, as he made his way out of his house in Rosaint village, Tonkolili district.
Before James became a CHW, people in his village, especially women and children, found it difficult to access treatment for common but dangerous ailments like malaria, diarrhea and pneumonia. Getting treatment for such illnesses at most times meant a seven-mile walk to the closest health facility leaving behind the other children at home.
His first stop for the day is the home of Fatmata Tarawallie and her 15-month-old son, Raymond Kamara. Fatmata says Raymond does not have a fever or diarrhea and has not been vomiting. Using his Middle-Upper Arm Circumference (MUAC) tape, James nonetheless screens Raymond to make sure he is not at risk of getting malnourished. James applauds Fatmata for looking after Raymond well and encourages her to keep up the good job.
Initially, Fatmata had not planned on giving birth in the local health facility because she thought she would be fine delivering on her own. It’s a decision frequently made by expectant mothers in Sierra Leone, and unfortunately a key reason behind the country having one of the world’s highest rates of maternal mortality.
But James was able to convince her otherwise. “I explained to her and her husband that because her feet and hands were swollen, she was at risk of having eclampsia (seizures) during delivery which untrained birth attendants will not be able to handle,” he said. James further alerted the local chief who made a decree to fine any woman who would attempt to deliver her or any other woman anywhere other than a health facility. Because of the fear of having eclampsia or other complications during delivery, Fatmata decided to go to a health facility to have her baby. At the hospital, health workers found out that her baby was breeched (a baby with its head turned away from the pelvis, making normal delivery risky), and she needed to have an operation. Fortunately for Fatmata, she was in the right place and both she and her baby were saved. “I am happy that I eventually listened to James and went to the hospital to give birth. I and my baby might have died if I hadn’t listened,” she said.
CHWs in Sierra Leone are important in creating connections between populations and the country’s healthcare delivery system, especially in hard to reach areas. CHWs played a key role in the response to the Ebola outbreak which ended up killing nearly 4,000 people.
In February the Ministry of Health and Sanitation launched a revised national CHW policy, which expands the scope of work for CHWs, who are now being provided with a more robust training, and will start receiving a monthly stipend of Le 100,000 (USD 16.5). “CHWs need to be provided with training in basic health care skills and some incentive to motivate them to efficiently deliver health services to the communities,” said George Sesay, Health Manager at the International Rescue Committee (IRC), UNICEF’s implementing partner for the CHW project in Tonkolili district.
Since 2012, IRC has worked with UNICEF to train and position 1,342 CHWs and their peer supervisors across all chiefdoms in the district. The project works closely with the Government’s District Health Management Team to supervise the CHWs to ensure they perform their duties as required, and improve maternal and child health in the district. With funds from the Government of Japan, these CHWs and their peer supervisors are trained on the revised national training curriculum; and they have continue promoting health and providing crucial maternal, newborn and child survival interventions.
As James rounds up his visit to Fatmata and gets ready to go to his next stop, she gives him a warm embrace as she expresses gratitude. “Thank you for helping me, my family and community to do the right thing for our own health. You saved our lives,” she said, smiling and pointing at herself and her son.