Health and the Rising Tide: Exploring the Gendered Dimensions of Community Health Worker Programmes in Sierra Leone Through Interactions with Water

Most countries in the global South have a shortage of formal health workers and are increasingly looking to community health workers (CHWs) to fill the gap. CHWs are arguably critical players in fragile and conflict-affected settings, such as Sierra Leone, where human resource shortages are particularly acute and played an important role during the recent Ebola outbreak. 

Our project (funded by DFID) looked at how the CHW cadre can be better supported and integrated into the health system in Sierra Leone. Several research methods were used, including photovoice. We focused on two districts with different context: Bonthe (riverine area) and Kenema; 15 CHWs were given a smartphone and training to take photographs of their work, their work environment, and their interactions with the health system over a three-month period.

The key learning points are that: CHWs are embedded in the communities that they serve and strategically placed to address challenges; context shapes vulnerability and access (flooding was a particular issue in Bonthe); CHWs can support changes in the community and feel empowered by this ability: CHWs have a unique and critical interface role that can help re-establish trust within health systems.

Submitted by:

Dr Aula Abbara

High tide at the market in Bonthe district

“This is inside the market, it is high water due to the sea tide. The presence of water is not good, because adults and children can be swiped off their feet by the current and drift into the sea. The market women climb on their stall to avoid the water”.

Photographer: Christiana Palmer

Working and playing in water in Bonthe district

“This picture shows some of the challenges we face living in a riverine area. We have a lot of stagnant water close to our homes which can serve as a breeding ground for mosquitoes which is bad for our health. Women and children use this area for work and play”.

Photographer: Dauda Rogers

Accessing vital childbirth services: the challenges of crossing the river in Bonthe district

“River Teteh poses a barrier to the community delaying pregnant women from reaching the health facilities which may cause infant and maternal mortality”.

Photographer: Isata Sheriff

Women’s actions to prevent infections in Kenema district

“This is a photo of a table built with sticks that is used to drain dishes and bowls away from the floor instead of draining them closer to the floor to prevent germs that might lead to diseases. This is a good concept that I introduced in the community”.

Photographer: Mamie Fadiru

Toilets without doors pose risks for girls

“This is not a good toilet because it doesn’t have a door and so provides no privacy. It is risky for girls to use these toilets.”
Photographer: Mamie Fadiru