Research

The Revised National Community Health Services Policy (2016-2021) (RNCHSP) and its program implementation, the Liberian National Community Health Assistant Program (NCHAP), exhibit a critical gender imbalance among Community Health Assistants (CHAs) as only 17% are women (MOH, 2016). This study was designed to assess the gender responsiveness of the RNCHSP and its program implementation in five counties across Liberia to identify opportunities to improve gender equity. The study found that despite the Government of Liberia’s intention to prioritize women in the recruitment and selection of CHAs, the planning and implementation of the RNCHSP were not gender responsive. The inequitable gender balance of CHAs has impacted the accessibility, acceptability, and affordability of community healthcare services, particularly among women. Strengthening gender responsiveness within the RNCHSP and its program implementation is key to fostering gender equity in the health workforce and strengthening a key pillar of the health system.

Key findings: In Grand Bassa County, Liberia, where Last Mile Health has managed implementation of the national program since 2018, care of childhood illness by a qualified provider increased by 60.3 percentage points more in areas where the national program has been implemented compared to areas where it has not. The evaluation also identified large improvements in two important components of care: receipt of oral rehydration therapy for diarrhea and rapid diagnostic testing for malaria. In addition, care by a community health worker increased from 0 to 81.6%, and care from unqualified providers decreased in intervention areas. Importantly, this evaluation found evidence that the Liberian National Community Health Assistant Program has increased access to effective care in rural Grand Bassa County.

Key Finding: Research from Exemplars in Global Health found that, relative to their peers, national community health worker programs in Bangladesh, Brazil, Ethiopia, and Liberia have made vital contributions to improving primary healthcare access. To achieve this success, these countries harnessed political will to mobilize government-led coordination, designed programs that respond to population needs, invested in comprehensive systems to support community health workers, cultivated community support and used data to continually refine and innovate.