Engaging Community Stakeholders Using Data for Decision Making to Improve an Urban Community Health Worker Program in the Slums of Freetown, Sierra Leone

BACKGROUND: There is renewed interest in and a growing body of evidence on Community Health Worker (CHW) programs. Some are credited with high population coverage of maternal and child health interventions and gains in child... [ view full abstract ]

BACKGROUND: There is renewed interest in and a growing body of evidence on Community Health Worker (CHW) programs. Some are credited with high population coverage of maternal and child health interventions and gains in child survival. The densely populated, unplanned and transient nature of urban environments requires special consideration. Concern Worldwide is implementing a five-year project in ten urban slums of Freetown, Sierra Leone to reduce maternal and child morbidity and mortality. Operational research (OR) is testing a participatory community-based health information system using data gathered by CHWs to determine if and how community stakeholders can use data for decision making, and whether this contributes to improved health behaviors and outcomes.

METHODS: 1,323 volunteer CHWs and Peer Supervisors were trained to make monthly home visits to disseminate health messages, check for danger signs and collect data on vital events and morbidity. In the OR intervention area, bimonthly community health data review (CHDR) meetings are conducted and CHW performance data and health data, including verbal autopsy results, are presented to community stakeholders.

RESULTS: To improve the quality of vital events registration and identification of children with serious morbidity, CHDR meetings have so far focused on CHW performance and data quality. Actions taken by the community demonstrate increased ownership of CHW activities by assigning community leaders to neighborhoods for supervision and follow-up. In intervention and comparison communities respectively, CHWs who complete monthly reports is 48% and 34%; Peer Supervisors reporting is 88% and 75%; and the average number of households reached per CHW per month is 16.5 and 13.4.

CONCLUSIONS: Preliminary evidence suggest that stakeholder engagement with data may help to improve the functionality of this urban CHW program; an integral step in achieving complete vital events registration and active monitoring of morbidity data to improve health outcomes.