For the community health workers (CHWs) of Bomi County, Liberia, timely access to health products and supplies means they can serve their communities. In Liberia, where nearly 30 percent of people live at least 5 km from the closest health facility, it can also mean the difference between life and death.
“We community health assistants (CHAs) need all the support we can get to treat those who need it most,” said Hope O. Elibor of her experience as a Community Health Services Supervisor (CHSS) who is assigned to Jenneh #3 and Bonjeh facilities.
When logistical support is unavailable, it can lead to health products and supplies not being distributed promptly, and the absence of supervision for CHAs has led to inconsistent consumption of data.
To achieve health care for all and to address the needs of even the most remote communities, we must first address the needs of the community health workers who serve them. That includes the CHAs of Bomi County.
CHWs in Bomi County
For many people living in remote areas in Liberia, CHAs are their only touchpoint with the public health system. But too often, they go without the resources they need to do their jobs effectively.
To improve product availability at the community level in the hardest-to-reach counties of Liberia, VillageReach partnered with the Liberian Ministry of Health (MoH) to connect CHAs to the country’s public health supply chain.
VillageReach commenced work in Bomi County in March 2022, giving technical support to the County Health Team (CHT) to strengthen the supply chain component of the National Community Health Assistant Program (NCHAP) by improving health products availability and supplies to CHAs.
This pilot project, funded by Global Fund, aims to transform how medicines get to CHAs, by utilizing people centered last mile delivery systems that will increase accessibility and availability of medicines at the last mile, where the CHAs serve. As part of the program, we are using kits to distribute commodities including supplies targeting malaria, diarrhea, pneumonia, and family planning complications, tailored to the needs of CHWs.
But producing these kits is only one part of a complex puzzle.
The Importance of Data
The Bomi County health team covers four health districts (Senjeh, Klay, Dowein, and Suehn Mecca), 24 public health facilities, 18 CHSSs, 177 CHAs, and 100 supported trained traditional midwives (TTMs).
Across the country, the MoH and central medicine store (CMS) are allocating health products following the last-mile distribution policy. While 80% are earmarked to the county health team to distribute to health facilities, 20% is allocated to NCHAP for distribution to CHAs.
However, to make sure these health products reach CHAs and the communities they serve, we need to improve both service and commodity consumption data quality and visibility by enhancing data collection methods through the use digital technology to record supply chain data in real-time, connecting that data to national logistics management information systems, and improve monitoring across the system. Through this project we are digitizing the paper-based community information including the logistics data to ensure decision makers have timely access to data to pack the kits at the central medical store based on the consumption trends of each individual CHA.
Enhancing the CHA Program with Consistency
Prior to their deployment in Bomi County, VillageReach performed county capacity assessments and stock verification baseline activities to capture the stock status at the facility and community levels.
Next, we used this feedback to inform the conduct of our monthly mentorship and coaching, activities at facilities, and communities with the aim of increasing visibility of the supply chain bottlenecks at the last mile. These exercises are conducted quarterly to assess improvements in commodity availability at the last mile.
Over the last 12 months we are seeing more health products and medicines reach the CHAs, enabling early treatment among children under five and improving access to reproductive health commodities for girls and women.
“If VillageReach continuously conducts the coaching visits, county capacity assessments, and commodities verification exercises, there will be improvement with the CHSS supportive supervision, CHA active routine outreach that will yield good results for the CHA program,” said Hope O. Elibor.
Improving Health Outcomes Through Sustainability
Bomi County’s CHAs are critical in providing preventive care, treating common illnesses, and orchestrating referrals to health facilities.
With consistent support from VillageReach at facilities and, most significantly, communities at the last mile, since the start of the project, there have been improvement in the CHA data quality, CHSS supportive supervision visits, and motivation for CHAs to provide services within their communities.
“VillageReach’s support has been vital to our work in the community and for the CHA program,” said Hawa M. Coleman, a CHA assigned to the Clean Town community.
By supporting the needs of CHWs, we can ensure they can achieve their full potential to improve health outcomes in communities and get supplies where they are needed most, bringing us one step closer to health care for all.