From Myth to Medicine

June 11, 2018  • Jordan Morrisey & IDEAS: the Magazine of the Aspen Institute

This article was originally printed in the Summer 2018 issue of IDEAS: the Magazine of the Aspen Institute.

In Bumban Kakaindayka, a community in Sierra Leone,most pregnant women prefer visiting nearby elderly “grannies” when they are ready to deliver their babies instead of visiting the area’s health clinics. Local lore holds that the herbs given to them by these grannies remove “excess water” in their bodies, thereby cleaning the child in the womb. Unfortunately, this kind of folk wisdom is one of the reasons why Sierra Leone’s maternal- and child-mortality rates rank among the world’s highest. “Changing ancient traditional beliefs cannot happen overnight,” Benito Conteh, a community health worker, says. “However, with training, mentoring, and supervision, we can identify danger signs in pregnant women and newborns, provide timely referrals, make household visits, monitor health behaviors, and support outreach and immunization interventions.”

The Aspen Management Partnership for Health, or AMP Health, works with ministries of health in sub-Saharan Africa to scale up national networks of community health workers—lay people who have been trained to deliver the basic life-saving services Conteh describes—in an effort to reach the hundreds of millions of rural people around the world with little or no access to modern health care. As a peer supervisor in a program supported by AMP Health, Conteh is also trained to supervise ten other community health workers in rural Sierra Leone.

The value of this work became startlingly clear in 2014, after the devastating Ebola outbreak in Sierra Leone. Community health workers were on the front lines of the fight against Ebola—detecting, reporting, and responding to one of the planet’s worst public-health crises. Without these trained personnel, many more people might have lost their lives. In the years since, and with the assistance of AMP Health, Sierra Leone’s Ministry of Health and Sanitation has committed to building a more resilient health system with a dedicated national hub to help its community health force reach more than seven million people.

Of course, health coverage is just one benefit of the partnership. Community health workers are among the most costeffective public health investments a country can make. Thanks to the increased productivity of a healthier population, the reduced risk of an epidemic, and higher employment rates, community health workers can provide a ten-to-one economic return on investment. This is vital in countries with high maternal-and child-mortality rates. “That is why we are throwing so much effort into the program,” Alpha Philip Bangura, the national coordinator for community health workers in Sierra Leone, explains. “If you identify the concentration of maternal and infant deaths, you discover that most happened because of a failure to refer, a failure to access community health facilities, negligence, tradition—lots of preventable reasons.” A robust system with enough community health workers to cover the entire country can combat these challenges and stimulate Sierra Leone’s economy.

Kiribakka Tendo, an AMP Health management partner, spends his days in the city of Freetown working closely with Bangura to strengthen the team’s leadership and management capacity. As Tendo puts it, this “usually means doing things faster, more efficiently, learning from other countries, and collaborating with other partners across the continent to get better results.” Recently, with AMP Health’s help, Bangura and his team, with Tendo’s support, were responsible for training 15,000 community health workers in just one year. “We are talking about nationwide coverage,” Bangura says. Organizing 15,000 people to do anything is challenging, but it’s even more difficult to accomplish in a resource-strapped environment. Luckily, AMP Health was able to leverage private-sector leadership and management know-how on behalf of the country’s health ministry. “The day-to-day work is very adaptive,” Tendo explains. “It’s innovative in the sense that we are trying to tackle the problem at the source: building people’s capacity to solve problems.”

After the innovation comes the actual training of 15,000 community health workers, which requires a lot of intense “logistical work,” Tendo says, like creating a database for keeping track of “who’s going to be trained, how are they selected, where are they selected from, all of that information.” In fact, Tendo believes the major problem in Africa is insufficient management. Corruption and a lack of resources, he explains, are just “symptoms” of the management problem. This theory is why Tendo left his job as an assistant vice president at Barclays in South Africa: he wanted to “be part of the solution to the management problem on the continent.”

Now that 15,000 community health workers are on hand, AMP Health is committed to equipping them to do the crucial work of expanding health care across Sierra Leone. Next up for AMP Health is helping the teams secure smartphones, an easy-to-use app, and other digital tools to improve data quality, workflow, and decision-making. Conteh is on board. “From the day I was identified as a community health worker,” he says. “I vowed to serve my community.”

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