But the programme still has its difficulties. In Nimba, Liberia’s second most populous county, community health workers report being overworked. Paye says she should be visiting five households a day in Gipo, but often it’s many more. “All day we are in the community,” she says.
Drug shortages are a regular occurrence in the county, which has porous borders with Guinea and the Ivory Coast. Supply chains must be improved, workers say, but demand is heightened by influxes of migrants visiting for free treatment. “The improvement has been immense,” says Ibrahim Kamara of Plan International, Nimba’s implementing partner. “But everyone wants a piece of the pie.”
The model has also yet to overcome gender barriers such as societal gender norms and literacy disparities. Just 17% of Liberia’s community health workers are female, which can be problematic if female patients aren’t comfortable interacting with a male health worker about pregnancy or reproductive health.
And while the priority for community health workers is the diagnosis and treatment of children under five for malaria, pneumonia and malnutrition in rural areas, Liberia’s wider population also has enormous health needs.
Yet amendments are on the way as Liberia’s scheme evolves to the end goal of universal health coverage.
In its second five-year strategy, set to come into effect later this year, reporting tools and methods are being improved – negative as well as positive malaria test results, for example, will be recorded. Training will be expanded from four to eight modules, including new areas such as administering injectable contraceptives, and to tackle the low numbers of female community health workers, the minimum requirement of sixth grade education will be dropped to open up access.
“We are on the right trajectory,” says Wiah. “But we want to see more being done.”
