Access to health information for action in an urban context: A participatory community based census in ten urban slums of Freetown, Sierra Leone

A key challenge in Sierra Leone is the lack of complete community health data especially in urban slums due to the population’s transient status and shifting geographical boundaries. This lack of data reduces the ability of health authorities to plan and respond effectively to health priorities. Concern Worldwide is testing a participatory community-based health information system (P-CBHIS), designed to improve community capacity to use health information for action. To establish the P-CBHIS, a household census was conducted in ten urban slum communities in Freetown to identify each household with a child under five years or a pregnant woman and to collect household asset data. A total of 230 community members were trained as enumerators and they identified 28,672 target households over an eight month period. The project census yielded figures different than the national census estimates due in part to variance in the definition of ‘resident’ and government versus community defined boundaries. Our urban census experience highlights how early engagement of community members as enumerators builds local capacity; cultivates trust, ownership, and a partnership approach to programming; promotes inter-community dialogue; fosters a greater understanding of and targeted responses to the health and socioeconomic context in their communities; and ensures coverage of every household when navigating a complex urban environment. Participatory community maps are vital for establishing boundaries and planning data collection. Beyond the P-CBHIS, the census results will be used to target vulnerable households, elect Community Health Workers, and share data to influence district and national policies.