Transformative Education
for Health Professionals

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Sierra Leone’s Community Health Officers

Abu A. Conteh Chief CHO MoHS, Jeri Sumitani MMSc, PA-C, Nadia Cobb MS, PA-C

Sierra Leone’s health care crisis has been highlighted through the Ebola epidemic. Numerous health care providers have died in the care of patients from ebola. The World Health Organization reports 1.9 physicians, nurses and midwives per 10,000 in 2011, with less than 150 physicians for a population of 6 million. The Community Health Officer is the primary provider at the community level.

Full project description: 

Faced with huge health care disparities, Sierra Leone expanded the health care provider team by adding Medical Assistants in 1980. The name was changed to Community Health Officers (CHO) after Sierra Leone adopted the Ouagadougou Declaration on Primary Health Care (2008) to demonstrate commitment to community healthcare. There are 1,228 Peripheral Health Units (PHU) in the country operating under the Ministry of Health, where Community Health Officers serve as the primary providers. At this time there are approximately 500 CHOs who have been trained in the country.

The training takes 3 years, including a practicum embedded in didactic sessions per semester, followed by 6 months to a year of housemanship. The curriculum has a very strong preventive emphasis to community health, including principles of public health (epidemiology, health statistics, demography). Didactic training takes place centrally at Njala University College  (University of Sierra Leone) Paramedical School in Bo.  Practicum training takes place in various PHUs in the districts.  The CHO curriculum has now been aligned to other Community Health Officer programs in neighboring West African countries as designated by West African Health Organization (WAHO). Graduates currently receive a Higher National Diploma in Community Health Sciences upon completion of program; there are plans to upgrade to a Bachelor of Science (BSc) degree by next academic year (2015-2016).

The CHO works under the Ministry of Health and Sanitation and are appointed to Community Health Centres in all 14 districts. They support District Primary Health Units consisting of Community Health Posts and Maternal Child Health Posts, and supervise Maternal Child Health Aids (MCHA) and Community Health Assistants (CHA) who staff these posts. They provide all aspects of primary health care to communities, including minor surgical procedures (ie. I&D, suturing, basic nursing procedures), basic diagnostic lab skills, and up-referral to the District Hospital for complicated or surgical cases requiring specialist management. They plan, implement and evaluate activities and resources of the primary health care unit, as well as collect, organize and analyze health and health-related data from health institutions, communities and other relevant areas.

A surgical CHO training is currently being piloted in Masanga; graduates from this pilot training are now practicing in District Hospitals performing surgical procedures with/without physician surgeon.  Other specialized CHO cadres such as Ophthalmic CHOs and mental health CHOs being piloted/developed.

Last February (2014)  the Sierra Leone Association of Community Health Officers hed their first Annual General Assembly. Its' theme was "Unity and service to humanity".


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