In Liberia, proactive population outreach activities occurred throughout the 2014 Ebola crisis and beyond, and were critical to maintaining access to PHC services, demonstrating the impact that population outreach can have on resilience. Prior to the Ebola crisis, a number of different primary health care related interventions had been implemented in Liberia including the National Strategy and Policy for Community Health Services which provided health promotion, case management, and integrated community case management (iCCM) by community health volunteers (subsequently referred to as CHWs). Although there were some challenges in implementation including unreliable drug supply, inadequate supervision, and lack of incentives, this infrastructure persisted throughout the Ebola crisis even as facility-based primary health care became inaccessible.
It is important to also note that approximately two-thirds of CHWs surveyed reported that they were afraid of contracting Ebola through their iCCM activities. “No-touch” iCCM guidelines were put in place during the outbreak to reduce the risk of Ebola transmission for CHWs, but it was challenging to disseminate these guidelines. Therefore, an important lesson from this outbreak was the importance of training CHWs in infectious disease prevention guidelines prior to outbreaks. Although the primary health care system in Liberia suffered immensely during the 2014 Ebola crisis, CHWs were able to ameliorate some of these consequences, particularly for children in need of treatment for pneumonia and diarrhea, due to their existing activities and ties to communities.1
Learn even more about CHWs in Liberia on the Exemplars in Global Health landing page.