Augustine Kargbo is passionate about the power of the community health workforce. “Having community health workers in these hard-to-reach areas, after delivery, they can monitor the mother and child,” says Augustine, who works as a supervisor in Tonkolili District, Sierra Leone. “I support the community health workers in their on-the-job training. I communicate with them when there is any health issue they need to act on immediately, like when there is a cholera outbreak, measles, yellow fever. We are working as a team.”
Supervisors like Augustine provide key support for Sierra Leone’s new national cadre of 8,000+ community health workers. The country’s latest policy calls for community health workers to provide a fully integrated package of essential primary health services, a key step in improving access to care for patients—but previously, there was no tool to guide supervisors to assess community health workers’ performance and determine what mentoring they needed.
In 2023, Last Mile Health and the Ministry of Health designed and pretested a digital tool that assesses community health workers’ performance. Accessed via a survey application on a smartphone, the tool draws from all community health worker training modules to measure performance, highlights where a community health worker has not met expectations, and asks the supervisor to review those topics with the community health worker during their supervision visit. In addition, all data from the tool is stored, and ultimately, the Ministry of Health will be able to leverage this data to develop a deeper understanding of community health trends, improving decision-making and helping to prioritize further actions. This means the tool will provide essential data for measuring the revised program’s overall success—and most importantly, it will give individual community health workers the support they need to provide quality care to patients.
For supervisors like Foday Bangura, the tool will standardize and streamline their work, ensuring consistent and clear expectations for the community health workers he supports and helping him identify gaps in their performance. “This is a great tool,” says Foday. “It will make my work easy because the supervisors will understand the community health workers’ lapses from the tool.”
Community health workers also found the tool helpful. “I like this tool because it assesses our knowledge in all aspects of the work we do,” says Chernor A. Kamara, who works in Samu Chiefdom. “It also assesses how we perform some procedures, like rapid diagnostic tests for malaria and middle-upper arm circumference for nutritional screening, which is good for us because some of us might miss some steps.”
Alusine Kamara, a community health worker from Munu Thallan Chiefdom, agrees. “This tool is really nice because it shows how I am doing on all the modules I learned during my training. It will make a community health worker serious about his or her work since the supervision process also asks community members about our work.”
During the pretest—designed and implemented as part of Last Mile Health’s commitment to ensuring new tools are functional, practical, and effective for community health workers and health leaders—15 peer supervisors used the tool with 41 community health workers in Kambia District. Additional trainings oriented district health management teams and national Ministry of Health staff to the tool as well as plans for its implementation, and data from the pretesting was analyzed and discussed with Kambia District health leaders: important steps toward ensuring a system-wide understanding of the tool so its data can be leveraged effectively.
Looking ahead, Last Mile Health and the Ministry will complete a full district pilot of the tool, incorporating feedback gathered during the pretest—and, based on this pilot, a broader rollout. Already, the tool was used by the national program in November 2023 in the supervision of 257 community health workers across all 16 districts in Sierra Leone.
“The process has provided guidance that will inform the tool’s full pilot and, ultimately, its nationwide uptake,” says Woria Salfin Marah, a community health system strengthening specialist on Last Mile Health’s Sierra Leone team. “This is an exciting step, as the tool fills a gap in Sierra Leone’s community health program. Before this tool, community health workers weren’t being supervised in a standard way. Supervision is critical to strengthening the health system through enhanced efficiency and data-driven decision-making, facilitating better coverage and quality patient care.”