| Group 1 and 2: Countries with U5MR < to 75 deaths / 1,000 live births |
| Senegal | High-level commitment and government leadership to scale up PHC: national health financing strategy developed; National UHC program defined; PHC review completed (2018–2019) National community health program 2019–2023 National health investment case developed; including community health component Various CHW cadres in place, mostly funded by external resources Engagement of local authorities for the management of health posts (case de santé) through local health development committee Ongoing resource mobilization efforts conducted, with a great focus on external resources CHW package of services defined; scale up of integrated services in most regions, including health and nutrition at the community level CHIS developed and integrated into DHIS2
| Increase domestic resources mobilization for community-based PHC by leveraging investments from local governments or other ministers (education, youth); Leverage innovative funding mechanisms: education and economic growth programs; co-financing/matching funds, trust funds with private sector Implement performance-based financing based on lessons learned from the pilot program and local contexts Work toward professionalizing CHWs to strengthen health systems Strengthen community-based logistic management system (forecasting, procurement, quality control) as well as last-mile distribution of essential drugs Scale up innovative technologies for better health management system, including information and logistics management systems Enhance social accountability mechanisms (community scorecards, observatories) and citizen engagement for better planning and monitoring with local communities Invest in the building and equipping health posts (case de santé) close to the communities in the deprived regions of the country
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| Liberia | High-level presidential engagement to scale to community health post Ebola virus disease-crisis (2016) Community health investment case completed; National community health policy developed Financing gap analysis and resource mobilization, with a main focus on external funding – international aid Roll-out of the national community health assistant program: training modules and tools developed; community health assistants and supervisors recruited and trained in selected regions CHIS is integrated into DHIS2; Ongoing digitalization of the system to strengthen CHW performance
| Strengthen the functionality of national coordination and governance mechanisms for PHC including community health Review of national community health policy as per WHO recent guidelines Build a pathway toward financial sustainability: develop clear gap analyses and financing pathways for the CHA program by leveraging domestic/ international resources, new funding sources including matching grants, co-investment with local governments as well as the private sector Work with local governments and other line ministries (decentralization, social welfare, youth, education) to ensure long-term availability of community health assistant (remote and rural areas) Fully integrate community-based LMIS into national LMIS and improve last-mile distribution of drugs Generate evidence on innovative approaches and best financing models for the national CHW program Develop referral systems with local governments and communities Enhance community governance and oversight mechanisms for the community health assistant program; establish community-based monitoring and social accountability systems
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| Group 3: Countries with U5MR Over 75 deaths/1,000 live births |
| Guinea | National health investment case developed; National community health policy developed (CHA profile harmonized) National intersectoral coordination mechanism established, under the leadership of the Ministry of Territorial Administration and Decentralization to support implementation of the national community health policy Resource mobilization through the National Financing Agency for local collectivities; financial contribution of local collectivities through their annual investment plan Implementation of the national CHA program in selected districts (mainly funded by donors): development of tools, training of CHAs Engagement of community leaders and networks in decision making and monitoring enhanced through local government structures and local committees Development of the CHIS (tools and modules)
| Raise awareness on specific community health policy issues (parliament, champions) Implement and expand pro-poor legislation and strategies (e.g., vouchers, community-based health insurance schemes) Develop clear gap analyses and financing pathways for costed CHW programs by leveraging domestic/international resources, new funding sources including matching grants, co-investment with local governments, disease surveillance and preparedness Leverage/strengthen innovative partnerships, especially with the private sector to scale up community health services Work toward integrating CHWs as part of the PHC multidisciplinary team and expand quality improvement mechanisms to increase CHW performance Develop and implement innovative and digital approaches to strengthen data collection and use at the community level Fully integrate community needs into the logistics management systems and ensure last-mile distribution of products Strengthen referral system between communities and health posts/facilities
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| Sierra Leone | High-level commitment at the presidential level for the UHC program; Review of PHC services completed CHW governance structure in place; Community health investment case developed (2017) Community health program review completed (2019); ongoing review and development of PHC model of care (2019-2020) Free Health Care initiative with essential commodities (includes amoxicillin, oral rehydration solution-zinc) Harmonization of CHW service delivery package, including the expansion of services to be provided by CHWs Deployment of a large number of more than 15,000 various CHW cadres under the leadership of the government, with the support of partners Review of the CHIS modules and integration into the DHIS2
| National health financing strategies should consider CHW systems within a broader framework of financing for UHC Mobilize domestic resource to support PHC services, including community health; Leverage/strengthen innovative partnerships, especially with the private sector to scale up community health services Review and harmonization of the CHW profile/cadre according to recent WHO guidelines; Mapping and redeployment of CHW as per recent needs assessment and equity analyses Work toward integrating CHWs as part of the PHC multidisciplinary team and expand quality improvement mechanisms Better integrated community needs into national logistics management information system and strengthen local system to ensure last mile distribution of drugs Develop digital approaches to strengthen data collection, analyses and use at the community level; roll out standard operating procedures for data quality Establish social accountability (scorecards, observatories) and citizen engagement mechanisms with communities
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