Where We Work : Sierra Leone : Health

In November 2008, BRAC started its Essential Health Care (EHC) programme in Sierra Leone with the objective to improve the general health status of the poor community women and their families by providing access to affordable primary health care services.

Health activities are based on a proven model of community health care in Bangladesh, which has been successfully adapted to serve communities in BRAC’s programmes in East Africa. In 2009, BRAC trained 20 Community Health Workers (CHWs) and 220 Community Health Volunteers (CHVs) to provide basic health care in Sierra Leone.

In order to make primary health care available to the microfinance communities BRAC works with, it launched its health programme outreaches in Sierra Leone in 2009. BRAC identified and trained 220 women from our microfinance groups to become CHVs, and employed 20 women as CHWs to supervise them. The women we select for the CHV training show a sincere interest in the role, have been recommended by their microfinance officer 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 CHV has the overall responsibility for 150-200 households in her area that she will visit every month – all within one kilometre from her home. CHVs earn a small income from selling health care products to other members, such as mosquito nets, oral rehydration solution (ORS), sanitary napkins contraceptive pills and hygienic soap. They also supply condoms for free. BRAC Sierra Leone has started a revolving fund supplying CHVs with a standard package of health items to promote and sell among their communities.

BRAC’s health programme takes a multi-pronged approach to reduce the health risks for poor communities in Sierra Leone. We focus on the prevention 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. In Sierra Leone, CHVs hold weekly meetings with their microfinance groups as well as monthly meetings for all community members in which common health issues are discussed. 

Programme Description

The BRAC Sierra Leone Essential Health Care 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 preventive 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 Volunteer (CHV). 

Programme Objectives

• To increase reproductive health care services by raising awareness, ensuring antenatal (ANC) and post-natal (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 reproductive health care awareness and service utilisation. To fulfil this objective, CHVs identify pregnant women during their household visits and refer them to nearby government or non-government health facilities. The CHVs raise awareness of pregnancy care and antenatal danger signs, and follow up to ensure that ANC and PNC visits to health facilities are made. The CHV 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 promising treatment against childhood malaria in Africa. She also raises awareness on the importance of Voluntary Counselling and Testing (VCT) for HIV/AIDS.

Malaria Control

During household visits, the CHV identifies suspected cases of malaria and refers the patients to the nearest health facility. She follows up to determine test results and see if the patient is taking their antimalarial medication. A relative of the patient is put in charge of supervising the drug intake according to their prescription. The CHV 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 CHV keeps records of this information in her household visit register.

The CHV sells Insecticide Treated Nets (ITN) in the community and promotes the concept of every family member sleeping under a net. She ensures that nets are treated every six months and sells K-O TABS, which are insecticides that are dissolved in water and sprayed on mosquito nets to restore potency.

TB Control

CHVs implement a well-tested community-based approach for increasing and sustaining TB case detection and treatment. During household visits, CHVs ask simple questions related to suspected TB cases (based on symptoms). When a suspected TB victim is identified, the CHV motivates that person to be tested at a 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 CHV 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 their medications, which results in drug resistance.

Family Planning

During regular household visits, the CHV mobilises and motivates women to use modern methods of contraception. She provides clients with birth control pills and condoms. For other temporary and/or permanent methods, couples are referred to government primary and secondary healthcare facilities.

Community Health Initiatives

BRAC takes a multi-pronged approach to community health education. We offer general community Health Forums on issues such as malaria, immunisation, TB and HIV prevention, maternal health, family planning, and sanitation, as well as weekly health meetings with the members of our microfinance groups.

Basic Curative Services

CHVs are trained to diagnose and treat some basic ailments such as diarrhoea, dysentery, common cold, helminthiasis, anaemia, ringworm, scabies, hyperacidity and angular stomatitis. They refer individuals with more complicated conditions to local, public and private health facilities. CHVs earn a small income by selling over-the counter medicines and health commodities, a portion of which BRAC supplies in kind as part of its revolving fund for CHVs.