Liberia's Community Health Assistant Program: Scale, Quality, and Resilience

Abstract

Liberia's national community health program went from dispersed pilots to nationwide scale within 4 years. n A network of policy entrepreneurs from the Liberian government, donors, and implementing partners capitalized on several windows of opportunity to achieve this success. * First, they seized the evidence from a series of pilot projects and-during a point of significant global momentum around community health-evaluated the agenda. * Second, they leveraged the impact of the community health workers during the Ebola virus disease outbreak to propel forward a consolidated, paid cadre with significant political and financial backing. n Policy makers and program managers should consider coalition building and identifying diverse champions as an essential ingredient for impacting large-scale change, even in the face of significant challenges. n Liberia's community health program is bolstered by significant research and evidence. However, the policy entrepreneurs who brought the community leaders, Government of Liberia stakeholders, donors, and partners around the table to buy into a common program has been the "secret sauce" of the program's success.

Impact of the Liberian National Community Health Assistant Program on Childhood Illness Treatment in Grand Bassa County, Liberia: A Difference-in-Differences Analysis of Population-Based Data

“…(25) While our evaluation only focuses on one portion of the country, Liberia's national program now covers over 80% of communities greater than 5km from health facilities, and we would expect similar impact across the national program. (14) Our findings add to a body of literature indicating that CHWs are an important aspect of rural primary care systems. Systematic reviews, however, have differed about the strength of evidence that community health worker programs produce meaningful improvements in child health outcomes.…”

“…Further details about CHA recruitment, training, supervision, incentives, and provision have been previously reported. (13,14,16)…”

“…The program uses an integrated and standardized approach in which CHWs, called community health assistants (CHAs), are trained and deliver a package of interventions in their communities. (13,14) However, the impact of implementation under the full national program on access and uptake of health services has not been assessed. Further, more data are needed to assess whether the program has been implemented in a way that equitably includes the most vulnerable populations.…”

Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All”

“… Work with governments to develop long-term strategies for increasing sustainable, domestic support needed for strong CHW programmes (as the Financing Alliance for Health [ 35 ] is doing). Develop strategies to build political will that can lead to more domestic investment for national CHW programmes [ 36 ]. Look for opportunities to cross-subsidize CHW programmes from other revenue streams within ministries of health, from the government more broadly, and from nongovernmental organizations (NGOs).…”

“…Develop strategies to build political will that can lead to more domestic investment for national CHW programmes [ 36 ].…”