Walking long distances on rugged, remote roads is part of Dinkie Kalie Marah’s daily routine. Since 2012, Dinkie has been a trained community health worker (CHW) and peer supervisor for Dolla Village, part of the Gberefeh Maternal and Child Health Post. Gberefeh is located in Morifindugu Chiefdom, Falaba District, and has several remote communities with an estimated population of over 18,000 people with little or no healthcare access.
“The terrain is rough here and some people live in difficult places, but I have to reach them, so I walk. Providing door-to-door integrated community case management is very challenging, but I’m determined to support my community [who wouldn’t have healthcare otherwise],” he said.
The main access route to these communities is through a swinging bridge (pictured below), which limits reliable access to essential services and makes potential referrals for critical care to secondary health facilities outside the region very challenging.
In Sierra Leone, the healthcare system frequently faces resource constraints and it is common to experience shortages of healthcare workers, especially in remote areas. Malaria remains a primary threat to millions in Sierra Leone, especially young children. To combine essential health services in hard-to-reach areas like Gberefeh, the World Health Organization recommends integrated community case management (iCCM) to overlap several health needs to provide care for those most at risk from malnutrition, diarrhea, and malaria in a single visit.
These diseases can be deadly for young children and often present with similar symptoms, such as fever. It is important to test and treat children quickly if they are showing symptoms to ensure they have the best chance of recovery. Community health workers like Dinkie play an essential role by filling the gap and increasing access to basic health services for rural, hard-to-reach areas by conducting iCCM in their communities.
“Every blessed day, I wake up as early as 6:00 AM to make sure that I’m ready by 7:00 AM [to open] my little verandah [to the community] to attend to the needs of pregnant women, children under five, and those with chronic illnesses,” he shared enthusiastically. Dinkie also pays daily visits of “up to 40 households in a day” to his patients in their homes, most of whom are children.
PMI Impact Malaria supports the Ministry of Health and Sanitation and the national malaria control program’s strategic malaria goals by providing supportive programmatic supervision of iCCM training and activities across 3 focus districts. This support included revision of the CHW policy and the recruitment and training of the new CHWs for the focus districts.
In early 2023, the U.S. President’s Malaria Initiative, in partnership with the Ministry and the CHW-Hub, conducted an assessment for an incentive payment system and spoke with CHWs in the 3 focus districts for their feedback. To support and facilitate CHWs’ service delivery, all the CHWs were to be provided with financial and non-financial incentives upon fulfilling the minimum requirements of their training.
While the Ministry and national government are establishing the financial payment system, PMI Impact Malaria and the CHW-Hub agreed to bridge the gap to ensure financial and non-financial incentives can be fulfilled for CHWs who have completed their training course and started working. This support allows CHWs to deliver the expected services to their communities.
Throughout May, the PMI Impact Malaria team in Sierra Leone traveled around to several remote communities to distribute the non-financial incentive materials to the CHWs. The items included backpacks, T-shirts, flashlights, and raingear. Each peer supervisor also received a bicycle and crash helmet to facilitate monitoring and supervision of CHWs. A total of 1,855 community health workers in the 3 focus districts, including Dinkie, received materials that will support their work to provide essential services and iCCM.
“A lot has changed for me in just a few short months since PMI took over the incentive payment and the procurement of non-financial incentive materials. My life has improved. They have empowered me with the necessary tools, and now I decide what to do with my additional incentive income. This motivates me to do more for my community,” said Dinkie. “I’m very grateful to USAID/PMI for supporting Community Health Worker Programs in Falaba District through the Ministry of Health and Sanitation. This has enabled us to deliver health services in marginalized and hard-to-reach communities.”
Supporting community health workers like Dinkie is important to bridge the gap in care for communities that are the hardest to reach with reliable health services. “Being a community health worker in remote areas like this with minimal access to the health facility is like running a 24-hour service” but it does not bother Dinkie because he has “dedicated my life to helping them,” he said. “This a tough terrain to navigate, and some of the villages are far between, but I love my job and will keep doing it. I’ve brought much-needed health services to my marginalized communities. This makes me very proud,” he shared.
PMI Impact Malaria is funded and technically assisted by the U.S. President’s Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, MCD Global Health, and the Malaria Elimination Initiative (MEI) at the University of California, San Francisco.