Scientific article
Open access

Optimising scale and deployment of community health workers in Sierra Leone: a geospatial analysis

Published inBMJ global health, vol. 7, no. 5, e008141
Publication date2022-05-19
First online date2022-05-19

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.

  • Accessmod
  • Sierra leone
  • Universal health coverage
  • Malaria
  • Health system strengthening
  • Child health
  • Health policy
  • Health systems
Citation (ISO format)
OLIPHANT, Nicholas Paul et al. Optimising scale and deployment of community health workers in Sierra Leone: a geospatial analysis. In: BMJ global health, 2022, vol. 7, n° 5, p. e008141. doi: 10.1136/bmjgh-2021-008141
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Article (Published version)
ISSN of the journal2059-7908

Technical informations

Creation05/19/2022 8:45:00 PM
First validation05/19/2022 8:45:00 PM
Update time03/16/2023 6:35:42 AM
Status update03/16/2023 6:35:41 AM
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