In 2024, Last Mile Health marked an exciting milestone in Sierra Leone: we began district-level operations in our Kambia District “learning lab,” where we implement performance and management tools to inform the scale of the national community health worker program. Building on work we have developed to target gaps in the community health system—which we’ve done alongside the Ministry of Health and key partners—our district-level work tests these tools in an applied setting. In turn, we leverage learning from Kambia to refine and improve approaches before working with the Ministry to scale them nationally.
Community health workers and peer supervisors in Kambia, Sierra Leone.
Our first major project in Kambia was an initial rollout of a supervision tool. The supervision tool is a digital checklist and action-planning guide that equips supervisors to work through each service community health workers provide, identify gaps and concerns, and make a plan for improvement. In December, we moved to a new round of on-the-job supervision for further testing of the tool. Our team traveled to communities across Kambia District to accompany supervisors as they conducted real-world, on-site supervision with community health workers. With Last Mile Health providing feedback and guidance during their visits within the community, peer supervisors were able to apply the tool in a practical setting and troubleshoot issues in real time, learning how to make the most of the tool and use their time effectively to coach the community health workers they supervise.
A peer supervisor uses the tool with community health workers to review services provided.
“The digital tool for supervision will make my job easier,” says Abu Samura, a peer supervisor who lives and works in the community of Kabalor. “Supervision helps the community health worker to improve on areas he or she does not understand. It will also help them to better perform their duties. During the supervision, we use the tool to develop an action plan after identifying areas for improvement, followed by mentorship and coaching.”
For the district health management team in Kambia, the new tool will help streamline and standardize supervision, strengthening the delivery of care. By accessing reports supervisors share via the digital tool, district health leaders can track challenges and progress—all within a standardized framework. It will help identify areas for improvement among community health workers as well as persistent delivery issues such as supply stock-outs. “The tool will pinpoint the areas we supervise where more action and attention is needed. It can also contribute to simplifying supervision activities,” says Joseph Conteh, the district team’s social mobilizer.
A supervision visit in the community.
Supervisor Abu Samura agrees, sharing that he feels prepared to implement the new tool in his daily work. “I will use it to do regular supervision for the community health workers,” he says. “I plan to use it to better understand the areas that need improvement. I will also use it as a guide to do my work and to plan my work effectively.”
With this phase complete, Last Mile Health is refining the tool and strengthening training processes based on data gathered. Then, we’ll launch, continuously monitor, and hand over the updated supervision tool and process guidelines to the Ministry of Health and other implementing partners: the first step in the national scaling of the tool.
Supervisor Abu Samura emphasizes the importance of strong supervision in ensuring community health workers can perform at their best—and the impact this will have on the care patients receive. “Supervision helps to improve mothers’ and children’s health,” he explains. “It will help the community health worker to understand their duties and responsibilities and regularly take action. It will lead to patient wellbeing because the supervisor will take their job seriously and be proactive in their duties.”
