A lack of running water. Leaking roofs. A dearth of essential drugs and basic vaccines.
It’s no wonder in communities throughout Sierra Leone, many people do not think of the local health facility as the first place to go for routine health care or for issues like illness or giving birth.
In turn, nurses and doctors are frustrated that community members do not visit health facilities regularly, making it more challenging for them to spread the word about potential health risks, preventative measures and healthy behaviors.The good news is that change is afoot.
In the facility makeover process, the community is engaged through dialogue, collaboration and outreach. The process begins with a series of dialogues to identify barriers to accessing health services at the facility and the repairs, renovations and improvements that can be done as part of the makeover to address these barriers. These initial dialogues take place first with community members, traditional leaders and leaders of groups within the community, separately from dialogues with facility staff and providers, and then the two groups are brought together to agree on the makeover priorities.
In addition to discussing the facility makeover, the community dialogues raise awareness about the health issues affecting the community and the importance of attending the facility, as well as motivate the participants to act in ways that help them, their families and their communities to become and remain healthy. The community dialogues follow the nine module Journey to a Bright Future (JBF) guide developed by HC3 and implemented by partner GOAL.
Many clinics throughout the country are in such a state of disrepair that they are not able to adequately serve the population within the catchment areas. With a lack of funding, facility staff previously had little hope for any repairs or improvements to be done. Due to the poor condition of the facilities, community members choose not to go to a there for their health needs or opt to travel longer distances even in the case of a health emergency.
By coming together to discuss these challenges and issues, the community and the facility staff and providers are able to overcome misunderstandings and conflicts related to the facilities. The community dialogues also help both sides recognize the importance of cooperation to reach their common health goals for themselves, their families and the community.
Involvement in these initial discussions builds community ownership over the makeover process and for the continued upkeep of the facilities.
The makeovers are completed largely by members of the community and the facility staff, with everyone contributing what they can. The paid laborers, including carpenters, masons and plumbers, are mostly members of the community. People contribute sticks for the fencing and tools to complete the work. Others climb up on ladders to repair roofs and ceilings and give a fresh coat of paint to the inside and outside of the facility, or grab a broom to clean the grounds and common areas of the facility. Community members also bring food and water for the workers and help with tasks such as fetching more water and mixing the cement.
Light repairs as well as a ‘freshening’ of the Health Post as well as the surrounding grounds are the basis of the makeover. Typical activities include repairs to the roof and ceiling, improving drainage systems, interior and exterior painting, renovation of rooms to better utilize available spaces, repairs to windows and doors, replacing concrete floors, fixing or installing solar electricity systems and refrigerators for vaccine storage, as well as an overall cleaning of the facility.
Work is conducted while the facility remains open and serving patients. Completing the makeovers during the rainy season adds to the challenge, yet community members and facility staff eagerly and excitedly pitch in.
As the makeover activities near completion, it draws the attention of other community members who come to see the work being done. Some are then inspired to contribute in their own way and, at many facilities, the communities’ work has gone beyond the initial makeover plan.
After the makeovers are completed the entire community will gather to celebrate their hard work in fixing up and tidying up the facility. However, the work doesn't end with the facility makeover. Additional community dialogues will be held to help communities understand when they should go to the facility and emphasize the importance of doing so. These messages will also be promoted through a nationwide campaign that includes a radio drama, radio spots that highlight the main message and themes, as well as community-level events. The campaign, called Get Kol Art, Pik Welbodi, focuses on reproductive, maternal, newborn and child health (RMNCH) to not only improve the current health in communities across the country but also support a healthier future for Sierra Leone.
After the makeovers are complete, communities celebrate the cooperation and contributions that made possible the repairs and improvements. They also pledge to continue working together to keep their facility clean and in a good state. Additional "after" photos will be posted as well as stories from the celebrations!
Watch the exuberant end of a community engagement event which took place in Kanikay in Sierra Leone.
HC3 is working to improve service uptake in the two other countries hit hardest by the Ebola outbreak, Guinea and Liberia (along with Sierra Leone, these countries make up the Mano River Region). In Guinea, similar makeovers have taken place. In Liberia, HC3 is working to build the capacity of Community Health Volunteers (CHVs) who are an essential link between the community and the health facility as well as promote compassion for health care workers through a mass media campaign.