ASSESSMENT OF COMMUNITY HEALTH PROGRAMS AND MAPPING OF Community Health Volunteers (CHVs) IN 88 HEALTH DISTRICTS OF LIBERIA

The EPHS maintains three levels of care: primary, secondary, and tertiary, with primary level care including community and health facilities. To increase access to health promotion and case management, a standard set of outreach, health promotion, referral, and case management of under-five services is provided for communities more than one hour's walk (5km and above) from the nearest health facility by Community Health Volunteers (CHVs). The Community Health Services Division worked with county health teams and partners to increase access to basic health services at the community level. The division has developed key documents, including the National Community Health Services Policy, the National Community Health Services Strategic Plan, and Operational Guidelines. A tentative listing of CHVs and Training of Trainers (ToTs) is established for 15 counties that need to be verified and validated. In addition to setting down a policy orientation for community health services in Liberia, the division conducted training of trainer's workshops for 507 health workers and 2,027 CHVs to implement integrated community case management in diarrhea for the 15 counties. A total of 103 CHVs out of 2,027 were trained to pilot integrated community case management of malaria and Acute Respiratory Infection (ARI) in Nimba, Bong, Lofa, and Gbarpolu counties. Based on the results and lessons learned from the six-month pilot, the Ministry planned to scale up the implementation of Integrated Community Case Management for malaria, diarrhea, and ARI. Since the pilot, the division and partners started the scale-up process in selected communities in some counties. Community Health Volunteers, including CHVs and ToTs, are providing some level of healthcare delivery services in communities all over the country. These services include nutrition, Expanded Programme on Immunization (EPI), integrated community case management for malaria, ARI, and diarrhea, TB/DOTS support, and awareness on prevailing health problems in communities. Many challenges were reported from the pilot, including the lack of coordination of community health services program planning and implementation, limited organized community health structures (CHCs/CHDCs), and many partners not adhering to the revised community health services policy and strategy planning and implementation of community health activities. Other issues were the lack of incentives and motivation for CHVs, which contributed to attrition and dropout from the program. In addition, inadequate supervision, frequent stockouts of essential supplies and drugs, especially anti-malarial drugs and Rapid Diagnostic Tests (RDTs), and standardized data collection tools were also noted. In an effort to address these challenges, it is prudent to conduct an assessment of community health program plans and implementations and mapping of functional CHVs and implementing partners. The main objective of the study is to conduct a comprehensive assessment of community health programs, including the profiling of community-level workers and mapping of services. The specific objectives are to establish a database, in accordance with the Community Health Services Policy and Strategy, that profiles all approved CHVs nationwide, to identify existing community structures (CHCs, CHDCs, CDCs, etc.) that support the delivery of community health services, to determine the services provided by different cadres of community-level workers, and to identify partners supporting community health activities, type of support, and motivation packages provided in the counties. The assessment will be a census of all active community-level health workers through direct contact with all workers. Data will be collected using paper-based collection instruments, and 88 district health officers (DHOs) will serve as supervisors of the community focal person in the health facility. The community focal person will visit every community with CHVs in the catchment area of the health facility to collect the profile of all workers and communities. The county coordinator will compile a listing of the names and contacts of all DHOs, facility OICs, Community Health Services supervisors, CHDD, Community focal persons, CHOs, etc. Training of the field personnel will occur at three levels: national, county, and district. At the national level, 15 county supervisors will be recruited and provided two days of training. They will be trained in the use of the instruments, training of, and supervision of the field work. In each county, the county supervisors will train the DHOs in the use of the instruments and how to provide support to the facility-based community focal persons. The DHOs will also be trained to double-check data submitted to them by the community focal person. The DHOs will bring together all facility community focal persons at the most centrally located health facility town in the district for a one-day training in the use of the instrument. The facility focal person will be trained to cross-check the data before submitting. The instrument will be pre-tested after the two-day training at the national level in an area outside of Monrovia. The questionnaire will then be finalized and bulk-printed after incorporating feedback from the pre-test session