BLOG - Overcoming the Burden of Distance to Improve People's Health

May 15, 2016 --- Gbarpolu County is one of the most newly established counties in Liberia. It is an incredibly diverse county with many cultures and tribes, and has high levels of poverty, a challenging road network – much of it next to impassable in the rainy season - as well as a lack of network connectivity.

It is extremely remote. From Bopolu, the county capital, to Kongbor district for instance, is about a 7 to 8 hour drive, and there is only one health facility providing services to all of the communities. The health challenges are extreme, but one partner, EQUIP Liberia, has achieved great success in engaging communities to take charge of their health through the ECAP 2 program, which has been funded by USAID and led by Mercy Corps.

In Gbarma and Kongba Districts, EQUIP Liberia has successfully established 80 functional community health committees (CHCs) in 80 communities. These CHCs are actively involved in community mobilization activities such as: sharing Ministry of Health-approved health information, doing awareness on community health issues, linking communities with health facilities, encouraging communities to trust and use clinics, carrying out cleanup campaigns, helping communities to identify potential health risks, and supporting them to address these challenges. 

The Officer-In Charge (OIC) of the Kongbor Clinic, the district’s one health facility states, “The attendance here at this facility has increased more than 300 percent. Before EQUIP started implementing the ECAP 2 program, attendance was between 5 and 10 people coming per day but now it has increased to about 45 to 50 patients. Patients come from far distances, even walking about 6 to 8 hours to get to this facility for health care”. 

There are many factors that have influenced Equip’s success in the field but our Research Team have identified the below as key:

Recruitment of field staff - EQUIP technique of selecting/recruiting their community support officers (CSOs) was one of the key factors attributed to the success of ECAP 2. EQUIP was strategic in selecting and assigning CSOs to communities based on experience working in the most challenging places, residency in the county and ability to speak the local languages of their assigned areas. Furthermore, the CSOs who were assigned to the most challenging areas, such as Kongba District where there is no network coverage and poor roads, were chosen also based on their passion and ability to handle extreme situations. 

Upwards and downwards information flows - EQUIP’s community engagement process has been vital to the success of ECAP 2 in Gbarpolu County.  The organization adopted a bottom-up approach: EQUIP started engaging the county authorities from the onset of the program and then went down to the community level to share information on the goals and objectives of the program, ensuring full participation throughout the project cycle. EQUIP organized kick-off conferences in all the districts where they are implementing ECAP 2 involving District Commissioners, Clan Chiefs, Paramount Chiefs, Town Chiefs and Elders. 

Regular monitoring and evaluation - The Management of EQUIP put in place a rigorous monitoring and supervision system to enhance implementation and impact. M&E and project officers persistently went to the field to identify progress and gaps or challenges and provide support in the response. 

Peer support and comradeship - Finally, peer support among field staff contributed to the success of EQUIP’s implementation. CSOs established a strong interpersonal relationship with each other in the field; they have been engaged with visiting one another’s assigned communities, sharing challenges and providing support to their colleagues. 

The ECAP 2 program has made a significant impact on the lives of the people in Gbarpolu County, specifically in in Gbarma and Kongbor Districts; our assessment interestingly identified that the inhabitants of these areas’ behaviors have changed positively. Community dwellers consider their health as a primary objective; they are developing their own health initiatives, trusting and using clinics, and articulating the benefits of such despite their remoteness and distances involved, and keeping their environments cleaner and healthier than ever before. Moreover, many of the communities’ CHCs are encouraging every household to take the initiative to construct a pit latrine attached to their house. Community members consider ECAP 2 to be a lifesaving mission, in a county where many had previously experienced very little contact with their health services.  

 

This blog has been authored by Chris Oscar, Rapid Research Officer at Mercy Corps Liberia.