Reaching the unreached: Improving the performance of community health volunteers and the district health system to increase health service delivery in hard-to-reach communities in rural Liberia – the Konobo experience

After fourteen years of civil war, Liberia faced a shortage of health professionals and a devastated infrastructure, leaving a significant percentage of the rural population without access to basic primary health care. To achieve the Millennium Development Goals and national health goals it is imperative to ensure that the most remote communities have access to quality health care at the community level. A solution to addressing this gap in Liberia and similarly resource challenged countries is an integrated model of healthcare delivery that combines innovations to improve the performance and capacity of community health volunteers. A pilot project, developed in partnership between the Liberian Ministry of Health and Social Welfare and NGO Last Mile Health, is significantly increasing access to health services across the remote district of Konobo. A cadre of 41 community health volunteers received an enhanced package of training, supervision and incentives. Data from the launch of the program in October 2012 to the end of 2013 shows significant impact on mothers and children under five, including a 50% increase in the number of children receiving malaria treatment, tripling the number of children treated for pneumonia/ARI, and ensuring that 96% of pregnant women have at least one antenatal care visit. This program is now being scaled up throughout additional rural Liberian districts and being incorporated into the Ministry’s National Roadmap for Community Health. As governments and partners in resource challenged countries seek to close gaps in rural healthcare, we propose a cost-effective model to increase quality healthcare access and utilization.