Optimising scale and deployment of community health workers in Sierra Leone: a geospatial analysis

BackgroundLittle is known about strategies for optimising the scale and deployment of community health workers (CHWs) to maximise geographic accessibility of primary healthcare services.MethodsWe used data from a national georeferenced census of CHWs and other spatial datasets in Sierra Leone to und...

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Bibliographic Details
Published in:	BMJ global health Vol. 7; no. 5; p. e008141
Main Authors:	Oliphant, Nicholas Paul, Ray, Nicolas, Curtis, Andrew, Musa, Elizabeth, Sesay, Momodu, Kandeh, Joseph, Kamara, Anitta, Hassen, Kebir, O’Connor, Shane, Suehiro, Yuki, Legesse, Hailemariam, Chimoun, Ebeny Francois Temgbait, Jackson, Debra, Doherty, Tanya
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group Ltd 01-05-2022 BMJ Publishing Group LTD BMJ Publishing Group
Subjects:	Africa South of the Sahara child health Community Health Workers Cost control Datasets Efficiency Geography Global health Health facilities health policy Health services health systems Humans Malaria Maternal & child health Original Research Planning public health Sanitation Sierra Leone Africa South of the Sahara Sierra Leone health systems health policy child health malaria public health
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Summary:	BackgroundLittle is known about strategies for optimising the scale and deployment of community health workers (CHWs) to maximise geographic accessibility of primary healthcare services.MethodsWe used data from a national georeferenced census of CHWs and other spatial datasets in Sierra Leone to undertake a geospatial analysis exploring optimisation of the scale and deployment of CHWs, with the aim of informing implementation of current CHW policy and future plans of the Ministry of Health and Sanitation.ResultsThe per cent of the population within 30 min walking to the nearest CHW with preservice training increased from 16.1% to 80.4% between 2000 and 2015. Contrary to current national policy, most of this increase occurred in areas within 3 km of a health facility where nearly two-thirds (64.5%) of CHWs were deployed. Ministry of Health and Sanitation-defined ‘easy-to-reach’ and ‘hard-to-reach’ areas, geographic areas that should be targeted for CHW deployment, were less well covered, with 19.2% and 34.6% of the population in 2015 beyond a 30 min walk to a CHW, respectively. Optimised CHW networks in these areas were more efficiently deployed than existing networks by 22.4%–71.9%, depending on targeting metric.InterpretationsOur analysis supports the Ministry of Health and Sanitation plan to rightsize and retarget the CHW workforce. Other countries in sub-Saharan Africa interested in optimising the scale and deployment of their CHW workforce in the context of broader human resources for health and health sector planning may look to Sierra Leone as an exemplar model from which to learn.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2059-7908 2059-7908
DOI:	10.1136/bmjgh-2021-008141