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.
Dr Aula Abbara
High tide at the market in Bonthe district
Photographer: Christiana Palmer
Working and playing in water in Bonthe district
Photographer: Dauda Rogers
Accessing vital childbirth services: the challenges of crossing the river in Bonthe district
Photographer: Isata Sheriff
Women’s actions to prevent infections in Kenema district
Photographer: Mamie Fadiru