Authors: Amy Nye, Lior Miller, and Nathan Blanchet
The successful rollout of Guinea’s National Community Health Strategy will require complex changes in health financing, human resources, and governance. To help Guinea independently translate, adapt, and sustain innovative ways to strengthen health systems, the Accelerator is facilitating dialogue with key partners and stakeholders to identify the most pressing challenges that are surfacing in implementation and scale up of Guinea’s National community Health Strategy. Although there has been excellent initial collaboration and cooperation among stakeholders, the existing health landscape in Guinea poses significant challenges for strengthening community health.
Guinea, which stretches from its capital city of Conakry on the coast of West Africa up into the Sahel region, has faced consistent health challenges. From the Ebola epidemic, which caused major disruptions to health service delivery and a significant loss of confidence, and fear, of the healthcare system to a chronically high infant and child mortality, with the most recent Demographic Health Survey (2018) reporting 1 child out of 15 dying before reaching his or her first birthday.
The lingering effects of the Ebola epidemic continue to exacerbate the ongoing challenges in Guinea, including understaffing, poor health system infrastructure, and poor management. Additionally, Guinea is currently grappling with how to continue providing essential services to communities while preventing the COVID- 19 pandemic from further exacerbating these trends in the country and eroding any progress to date.
In an effort to improve community health in Guinea, the Ministry of Health developed the National Community Health Strategy in 2018. The centerpiece of that strategy is the recruitment, training, and salaried payment of Community Mobilizers, or Relais Communautaire (RECO) and Community Health Workers, or Agent Santé Communautaire (ASC); but a myriad of other financing and governance changes will also be required to enable and sustain those workers.
If the strategy can be rolled out successfully, it holds tremendous potential for Guineans’ most pressing health burdens and future risks. The ASC and RECO increase access to essential care by conducting health outreach and education activities and by facilitating engagement between health centers and the community. The ASC and RECO also play a critical role in referrals to the health system, and in leading promotional, preventative, and curative services in areas like nutrition, maternal, newborn, and child health, transmissible and non-transmissible diseases, and many others. As the face of the health system at the community level, ASC and RECO play a critical role in rebuilding trust in the health system that was fragmented during the Ebola epidemic. As the strategy is designed to hire ASC and RECO from within their own communities, they are well poised to build trust and rapport. In their role as front-line responders, they are sometimes the first providers to detect infectious diseases and notify communities and authorities during a pandemic such as COVID-19.
The Guinean government, along with a wide array of funders and implementing partners, are committed to the implementation and scale up of this new health strategy, although the rollout has not been without challenges, particularly given the emergence of the COVID-19 pandemic.
In support of the government’s efforts to roll out the National Community Health Strategy, the Accelerator has carried out in-depth interviews with key stakeholders and reviewed policy and implementation documents to identify the key challenges and opportunities for strengthening implementation. Strengths of the strategy include:
- Clear, detailed, and well-communicated strategy
- Buy in and investment from key stakeholders in the community health system
- Leadership and vision from key government stakeholders
Challenges that key stakeholders have faced in implementing the strategy include:
- Lack of coordination and efficiency in the implementation of the National Community Health Strategy among different levels and sectors of the government and partners
- Gaps in sustainable financial support and execution for all parts of the strategy, including salaries, equipment, supplies, etc.
- Poor retention of ASC and RECO, particularly in rural areas
- Challenges in operationalizing the Community Health Strategy during COVID-19, as well a lack of clear definition of the role ASC and RECO can or should play in the pandemic response at the local level
- Lack of a learning and adaptation plan for the implementation of the strategic plan
- Poor quality of community health data
In order to address these challenges, the Accelerator is embarking on a virtual co-creation process with the key stakeholders in the community health system in Guinea. The Accelerator will organize thematic groups that address these key challenges. Initial thematic groups include financing of the community health strategy, decentralized roles and responsibilities within the community health strategy, and the learning agenda for the community health strategy. Over the coming months, each of the thematic groups will convene approximately two times to come to a consensus around the key challenges and key questions for their topic of focus and discuss root causes and possible solutions. The outcome of these thematic group meetings will be concrete actions that stakeholders can tackle to address the key challenges. Finally, the Accelerator will convene all thematic groups into one large webinar to present and synthesize the findings and analysis of each group.
The co-creation process being led by the Accelerator, and the workplans and action items that come out of the co-creation process, will lead to improved implementation of the strategic plan, enabling ASC and RECO to more effectively fill their roles and reach more community members with essential services. Implementing the National Community Health Strategy at full capacity will lead to sustainable change and a more resilient and responsive health system in Guinea.