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Scholarships for Community Health Officers

Project

In 2006, The Kambia Appeal was asked by the Kambia District Medical Officer and the Chairman of the District Council to help increase the number of permanent medical staff in the district by supporting the training of new Community Health Officers (CHOs).

CHOs act as paramedics in charge of rural health clinics and can carry out life-saving medical interventions and basic surgery. More skilled than trained nurses, CHOs are doctors in all but name. Their training, which takes place at the Njalla University in Bo, Sierra Leone, lasts three years, as opposed to seven years for doctors, and is therefore more cost-effective.

The Appeal has already supported one student from Kambia, Joseph Kalokoh, through his first year of CHO training. Joseph had previously worked as a volunteer theatre assistant at the Kambia hospital for a number of years, and having gained a distinction in his first year exams in July 2007, we are delighted to be supporting his studies for the next two years. Building on our experience of helping Joseph, we have now responded to the request for assistance by providing seven further scholarships to current CHO students from Kambia, this at a cost of just over £1,000 per student per year. This amount covers tuition fees, accommodation at the university student hostel and a living allowance.

The District Medical Officer has identified seven students who originate from Kambia who, like Joseph, are now in their second year of study at Njalla. To date, their tuition fees have been covered by the Kambia District Council and, along with Joseph, they have completed and passed the first year of the CHO course, and so have proved their academic ability and commitment.

The eight students have signed an agreement with the Kambia District Council to work in Kambia for the health services for a minimum of three years beyond graduation. With our assistance, these eight new CHOs will be working in Kambia by September 2009.

Background information

Although the civil war in Sierra Leone ended in 2002, post conflict recovery is extremely slow, with central infrastructure and basic services still in need of major renovation and investment. The health services in particular are severely depleted, with the chronic shortage of appropriately trained staff being one of the major problems impeding progress.

The following points, taken from “The Sierra Leone Human Resource For Health Development Plan 2006-2010” compiled by the Ministry of Health and Sanitation, summarise the problems and highlight the rationale behind our Scholarship project:

Lack of key staff

A lack of key staff not only compromises the service at district hospitals but also affects the rural health centres which depend on the hospitals for supervision and support.

Kambia District has just one qualified doctors, servicing a population of 337,212. He is the District Medical Officer, chiefly an administrative role overseeing the medical services in the whole district, with limited time for clinical work. Beyond the hospital there are over 30 rural health clinics in Kambia. Each should be run and managed by a qualified CHO, but there are currently only three CHOs working in Kambia, and two of these are based at the district hospital to cover nurse shortages.

Lack of Deployment Policy

Staff of The Ministry of Health and Sanitation are allocated to different facilities from a central pool, a system which enables staff to accept or reject postings. Therefore, Kambia, a poor rural district six hours drive away from the capital Freetown, is not an attractive posting for new staff. It is extremely difficult to attract non-Kambians to work there.

The Age Distribution of medical staff

Almost a quarter of all trained health workers in Sierra Leone should be retiring in the next five years.

Pay and working conditions

Most newly qualified personnel join the private health sector or work directly for foreign NGOs as a result of the lengthy time it takes to get employment by the government. Also, new personnel often do not get paid in their first few years of service, a practice that is widespread for all civil servants, including teachers. This increases the reluctance of personnel to work in areas away from their own homes and family support network.

Globalisation of Health Care Professional Labour Market

The health care labour market has been internationalised, creating staffing shortages in The Ministry of Health and Sanitation, as highly skilled professionals leave Sierra Leone to work abroad.

High student dropout rate

Dropout rates are high across all the basic health training schools in Sierra Leone. The rate for CHOs is 17%. This is due to inadequate or erratic government bursary funding and a lack of funding for student accommodation, living costs and affordable learning materials.

Benefits of Providing Scholarships to CHO students

One of the main benefits of investing in CHOs in Sierra Leone is that the qualification is not recognised outside the developing world, so there is less chance of newly-qualified personnel leaving the country in which they have been trained.

Our CHO students are all native born of Kambia District, and so they have more incentive to remain in Kambia beyond the stipulated 5-year term, having a greater sense of commitment to the communities they will serve as health professionals. They will also be able to draw on family support during their first years of employment.

The Kambia Appeal Scholarships give the students financial security for the duration of their studies, so they have the best chance of completing the course programme. The Scholarships include a regular living allowance of £45 per month, plus funds to cover the cost of buying learning materials, including textbooks.

Once qualified, each CHO will be in charge of a rural health centre, each serving communities of between 6,500 to 15,000 people. As well as providing clinical care for the local populations, CHOs are responsible for training existing staff, including auxiliary midwives, and health volunteers in the area, such as Traditional Birth Attendants.

Budget

The costs per student for one year are as follows:

University Tuition Fees £ 350

Accommodation £ 65

Living Allowance £ 535

Learning materials £ 220

Total £1,170

The total cost of providing scholarships for all 8 CHO students for one year is be £9,360. The costs for the 2008/09 academic year are expected to remain the same, so the total cost for providing 8 new CHOs for Kambia will be £18,720. We are extremely grateful to the individuals who have given generous donations to guarantee the success of this project, principally the Trustees of the Martin Smith Foundation and the many supporters of the Kambia Golf Day 2006.

December 2007 Visit to Kambia

In December 2007, James Dowling met the seven new recruits and asked them to write about themselves and their reasons for wanting to become key players in the health system in Kambia. Here is what they wrote:

	Hassan Bangura I was born 31 years ago at Mababda village in the Tonko Limba chiefdom of Kambia District. I attended the St Martin de Porres Primary School in Malikia, about five miles south of my home village, the Government Secondary School in Madina, and the Forces Nurses Training School in Wilberforce, Freetown, where I was trained as a State Enrolled Community Health Nurse from 2000 to 2003.  I am currently in the second year of the Higher Diploma in CHO at Njala University.  I am very grateful to the Kambia Appeal to supporting my curren t studies.
CHOs are trained to work in communities in order to improve the health of the population.  Having looked at the health situation in Kambia District I thought it fit t go through this training so that I can come back and contribute meaningfully to improve the health status of the district, as there are presently very few CHOs working here.   After the training, I expect to be posted to one of the community health centres where I will represent the District Medical Officer and the  Ministry of Health in solving health problems.  My main functions will be:   To treat all minor ailments and make prompt referrals to the district hospital when necessary To supervise the activities of other staff members at the health centre To work closely with the community in terms of environmental sanitation (refuse disposal and water   management) To supervise the other peripheral health units in the chiefdom   To send monthly reports to the District Health management Team In my leisure time, I like playing games and watching European football, especially the English Premier League.  I am single.
Elizabeth Konteh I am a native born of Kambia District from Rogberay village.  I was born on 15 September 1977 and I am currently studying to be a Community Health Officer in Bo at the Njala University.   Why I prefer to be trained as a CHO is to help my people in Kambia and to help improve the maternal and mortality rate in the district, and to improve personal hygiene and waste management.   I am grateful to the Kambia Appeal and the people of Cheltenham for helping me because I do not have anyone else to support my academic work.  As a student I was facing many constraints in terms of paying for my tuition fees, the practical work at health centres and transportation, buying text books and accommodation. My hobbies are films and playing sports, and my friends.
Alhassan M. Sumah My name is Alhassan.  I am a native born of Rogberay village in Kambia District.  I am 30 years of age. I attended Kambia District Committee Primary School and then Kolenten Secondary School.  My father died at an early age but my mother still lives in Rogberay with four children.  I decided to become a CHO because I want to help my people who need a great deal of help for their health. I look forward to working in Kambia when I have finished my course.
Michael A Bangura   I was born in the Magbema Chiefdom of Kambia District, and I am 30 years old.  In 2005 I deemed it necessary to pursue health studies to equip me to help my people.  I am presently studying to become a CHO, in the final year of the course in Bo.  I am single. I attended my secondary school also in Bo and my primary school in Dam Town in Kailahun District.  As for my hobbies, I love friends in and out of my country.  At school I had many pen pals around the world. I also love sporting activities like football, and movies.   As a CHO I will be working with my community and doing health centre management, diagnosing diseases, referals to specialists and giving treatments. I know I will be facing problems with maternal health, which will need my management skills acquired at university and practical knowledge. I believe I will also face the problem of how to work with the community on issues like sanitation and hygiene. I will work on the prevention and control of diseases at my health centre rather than just relying on curative medicine alone. I am confident that the catchment area where I will work as a CHO will be a place where not only my community will be happy to live but myself too. My intention is to improve health for all. Thank you for your assistance.
Mohamed K S Koroma   I was born on 27 April 1978 in Rokupur Town in Kambia District, where I attended the R.C. Primary School and the Ahmadigya Secondary School.  I sat my GCSEs in 1997. The ten-year civil war in our country forcefully moved me to Lunghi, near the International Airport, where I stayed for sometime.  I entered the School of Community Health Sciences in Bo in 2006.  I am now in my second year of studies.  I like playing football and watching sports.   The CHO course is important to me because I want to meet local communities to find out their disease related problems, to treat them and educate them about health issues.  CHOs are important for Kambia because there are a lot of untrained people practicing native medicine, who move around the district treating people and causing a lot of problems for people’s health.  In this respect I believe that after completing my course I will come and work with my people to provide basic health care.  As I CHO I will be expected to treat people myself or refer cases to the district hospital.  Thank you to Cheltenham for giving me this opportunity.
Bai S. Sankoh   I was born in 1977 in Masunta village in the Tonko Limba chiefdom of Kambia, so I am a Limba by tribe and a Sierra Leonean by nationality.  I am in my final year of my training at Njala University to become a CHO. As a native of Kambia I know the health problems that the people face everyday.  I give my word to return to Kambia to work hard as a CHO to treat and educate the people to improve their health. I will qualify in the summer of 2008.
Mohamed Al Kamara I was born on 22 September 1974 in Rokupa Town in the Magbema Chiefdom of Kambia District.  I attended the Sierra Leone Muslim Brotherhood Primary School in my home town. I completed my further education at the Ahmadiyya Muslim Secondary School at the Kissy Dockyard in Freetown in 1991, but due to the war in Sierra Leone, which killed my mother and father in our house in Rokupa, I could not begin university study until 2006. I am now in the second year of my studies at Bo.     I am trying my level best to become a CHO in my lifetime so that I am able to reduce mortality and morbidity in my district of origin.  I chose to be a CHO when I learnt that there are only three CHOs in Kambia and that these cannot speak the my district’s local languages, so people find it difficult to explain their health problems to the medical staff.  When I am qualified my community may not have fear in me because I speak their own tongue. I am coming back to Kambia to help the District Medical Officer and his team. I thank The Kambia Appeal for allowing me to achieve this.

The new Kambia Appeal Scholars at the KA Base, January 2008.