Community Health Workers in Liberia
Crisis propels country to extend reach of health system and increase demand for care
The speed of the scale-up of Liberia’s premier community health worker program - the National Community Health Assistant Program - is remarkable, given the country’s extreme poverty and recent history of civil war and epidemic.
Liberia demonstrates that even extremely low-resourced countries with remote populations can implement CHW programming that can improve health broadly.
Donor management and strong government vision
Liberia provided a clear and persuasive policy vision and pushed donors to provide transparency on funding capabilities and contingencies.
Liberia took a proactive stance with donors. It did not merely accept donors’ plans but instead responded to funders’ offers with its own research and vision to maximize impact and fill critical gaps. As Liberia tracked and mapped each donor’s priorities, the country pushed less transparent donors to become more forthcoming about their own funding requirements. This approach proved remarkably successful. As of 2019, almost every major health sector development donor is funding some aspect of Liberia’s CHW program.
Invest in data systems
CHW program was built with robust support systems including monitoring and evaluation, training, and supervision for CHWs.
Design with financial sustainability in mind
Tailor-made costing tools allowed planners to understand cost implications of CHW design elements.
Leverage windows of opportunity
The Ebola epidemic demonstrated the need for a resilient primary health care system and the value of CHWs. CHW program champions used this experience—and President Ellen Johnson Sirleaf’s desire for a legacy for her administration—to build momentum.
Use an iterative approach
Liberia began experimenting with CHW programing in 2007 and has continually adapted and adjusted its programmatic model to reflects learnings. Regularly scheduled policy reviews of the program help identify gaps, challenges, and successes.
The country’s initial CHW program relied on volunteers in peri-urban areas. Evaluations of that program informed a 2012 CHW pilot program for rural areas with paid CHWs developed by the Ministry of Health and NGO partner Last Mile Health. Findings from the pilot showed significant improvements in access to health care for children and pregnant women. The pilot, which allowed the ministry to test and revise program elements, was eventually scaled nationally, with minimal changes, in 2016.