Where We Work : Liberia : Health

In November 2008, BRAC began community activities under its Health Programme in Liberia. Health activities are based on a proven model of community health care in Bangladesh which is also successfully applied in BRAC’s programmes in East Africa. In 2009, we trained 40 health workers and 197 health promoters to provide basic health care in Liberia.

Health care and microfinance are inter-related. Poor women who finance their small businesses through microloans cannot afford to be ill – they have to work every day to make enough money to feed their families. If anyone is sick, food money is spent on costly medicine and income is lost through nonworking days.

In order to make primary health care available to the microfinance communities we work with, BRAC launched its health programme in Liberia in 2008.

BRAC identified and trained 197 women from our microfinance groups to become Community Health Promoters, or CHPs, and employed 40 women as Community Health Workers (CHWs) to supervise them. The women we select for the CHP training show a sincere interest in the role, have been recommended by their microfinance officers and have a business that gives them time to do rounds. They are the central point of contact for the health concerns of the microfinance group members, their family members and the wider community.

Each CHP has the overall responsibility for 150-200 households in her area that she will visit every month – all within one kilometre from her home. CHPs earn a small income from selling health care products to other members, such as condoms, oral rehydration solution, sanitary napkins, hygienic soap, water purification tablets and some over-the-counter drugs, such as paracetamol, anti-histamine and antacid.

BRAC’s health programme takes a multi-pronged approach to reduce the health risks for poor communities in Liberia. We focus on the prevention and control of malaria, tuberculosis (TB) and HIV/AIDS, the reduction of infant and under-five mortality rates, and increasing accessibility to health by taking health care to the doorstep of the people.


Programme Description

The BRAC Liberia Essential Healthcare Programme (EHC) is a scalable model of community health care. The overall goal of the EHC Programme is to improve health conditions and increase access to health services by providing basic health services in communities where BRAC has an established microfinance group. One member of each BRAC borrowing group is designated and trained as a Community Health Promoter (CHP). CHPs serve the health needs of the entire community, with particular attention to poor women and children.

Programme Objectives

• To increase reproductive health care services by raising awareness, ensuring antenatal care (ANC) and post natal care (PNC) visits and facility-based deliveries;
• To reduce the incidence of malaria, especially among pregnant women and children, by enhancing control and prevention;
• To bring positive behavioural change for prevention of HIV/AIDS and ensuring access to HIV/AIDS services through community sensitisation and participation;
• To develop a community-based approach to increase and sustain TB case detection and cure rate as per the Millennium Development Goals;
• To improve basic sanitation and hygiene by bringing behavioural change and ensuring access to safe water and latrines;
• To mobilise women and disseminate information through village meetings and home visits;
• To collaborate with the Government to further facilitate and strengthen the implementation of national tuberculosis, malaria and immunisation programmes.

Programme Components

Reproductive Health Care

One of BRAC’s primary concerns is to improve maternal health care awareness and service utilisation. To fulfil this objective, CHPs identify pregnant women during their household visits and refer them to nearby government or non-government health facilities. The CHPs raise awareness of pregnancy care and pre-natal danger signs and follow up to ensure that ANC and PNC visits to health facilities are made. The CHP keeps a check on whether her clients have taken their Tetanus Toxoid (TT) doses and completed the Intermittent Presumptive Therapy (IPT) course, which is a preventive measure against malaria for women in Africa during pregnancy. She also raises awareness on the importance of Voluntary Counselling and Testing (VCT) for HIV/AIDS.

Malaria Prevention and Control

During household visits, the CHP identifies suspected cases of malaria and refers the patients to the nearest health facilities. She follows up to determine test results and then to see if the patient is taking their anti-malarial medication. A relative of the patient is put in charge of supervising the drug intake according to their prescription. The CHP then conducts a follow-up visit to ensure the patient’s recovery and to make sure that the patient has not developed further complications. The CHP keeps records of this information in her household visit register.

TB Prevention and Control

CHVs implement a well-tested community-based approach for increasing and sustaining TB case detection and treatment. During household visits, CHPs ask simple questions related to suspected TB cases (based on symptoms). When a suspected TB victim is identified, the CHP motivates that person to be tested at a nearby health facility. She explains the dangers that TB can pose to the sick person as well as the rest of the family. She then follows up on the patient to determine the test results. If the patient tests positive, the CHP can also act as a Direct Observation Treatment Short Course (DOTS) agent. DOTS involves second party observation of a TB infected person taking a prescribed course of medication so that the patient does not default on taking medication, which results in drug resistance.

Family Planning

During regular household visits, the CHP mobilises and motivates women to use modern methods of contraception. She provides clients with condoms. For other temporary and/or permanent methods, couples are referred to then nearest healthcare facilities.

Community Health and Nutrition Education

BRAC takes a multi-pronged approach to community health education to sensitise women about basic health care needs and practices. We offer community Health Forums on issues such as malaria, immunisation, TB and HIV prevention, maternal health, family planning, and water, sanitation and hygiene.

Basic Curative Services

CHPs are trained to diagnose and treat some common ailments such as diarrhoea, dysentery, common cold and fever, helminthiasis, anaemia, ringworm, scabies, hyperacidity, angular stomatitis and iodine deficiency syndrome. They refer individuals with more complicated conditions to local public and private health facilities. CHPs earn a small income by selling over-the counter medicines and health commodities to patients and community members.