RT Journal Article
SR Electronic
T1 Optimising scale and deployment of community health workers in Sierra Leone: a geospatial analysis
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e008141
DO 10.1136/bmjgh-2021-008141
VO 7
IS 5
A1 Nicholas Paul Oliphant
A1 Nicolas Ray
A1 Andrew Curtis
A1 Elizabeth Musa
A1 Momodu Sesay
A1 Joseph Kandeh
A1 Anitta Kamara
A1 Kebir Hassen
A1 Shane O’Connor
A1 Yuki Suehiro
A1 Hailemariam Legesse
A1 Ebeny Francois Temgbait Chimoun
A1 Debra Jackson
A1 Tanya Doherty
YR 2022
UL http://gh.bmj.com/content/7/5/e008141.abstract
AB Background Little is known about strategies for optimising the scale and deployment of community health workers (CHWs) to maximise geographic accessibility of primary healthcare services.Methods We used data from a national georeferenced census of CHWs and other spatial datasets in Sierra Leone to undertake a geospatial analysis exploring optimisation of the scale and deployment of CHWs, with the aim of informing implementation of current CHW policy and future plans of the Ministry of Health and Sanitation.Results The per cent of the population within 30 min walking to the nearest CHW with preservice training increased from 16.1% to 80.4% between 2000 and 2015. Contrary to current national policy, most of this increase occurred in areas within 3 km of a health facility where nearly two-thirds (64.5%) of CHWs were deployed. Ministry of Health and Sanitation-defined ‘easy-to-reach’ and ‘hard-to-reach’ areas, geographic areas that should be targeted for CHW deployment, were less well covered, with 19.2% and 34.6% of the population in 2015 beyond a 30 min walk to a CHW, respectively. Optimised CHW networks in these areas were more efficiently deployed than existing networks by 22.4%–71.9%, depending on targeting metric.Interpretations Our analysis supports the Ministry of Health and Sanitation plan to rightsize and retarget the CHW workforce. Other countries in sub-Saharan Africa interested in optimising the scale and deployment of their CHW workforce in the context of broader human resources for health and health sector planning may look to Sierra Leone as an exemplar model from which to learn.Data are available in a public, open access repository. Data are available in a public, open access repository under the Creative Commons Attribution 4.0 Unported (CC BY 4.0) licence, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. Supplemental appendices 2-4, video 1, all model inputs (except existing service delivery locations) and all model outputs are available in supplemental appendix 1b at https://doi.org/10.5281/zenodo.5712134. Health service delivery location data are only available through data sharing agreements with the MOHS and UNICEF.