Implementation Research on the National Community Health Policy in Guinea
Guinea’s health system faces significant challenges, including understaffing, inadequate infrastructure, and poor management. Guinea is currently grappling with how to continue providing essential services to communities while responding to the current Ebola outbreak and the COVID- 19 pandemic. In 2018, the Ministry of Health (MOH) launched the National Community Health Policy to improve community health. The centerpiece of that policy is the recruitment, training, and salaried payment of Community Relays and Community Health Workers (CHWs). However, a myriad of financing and governance changes are required to create the enabling environment required for these health workers to be effective. The Government of Guinea, partners, and donors have invested significant resources in the country’s community health program and in decentralization efforts, however, there has not been any implementation research to date specifically examining the intersection of these two complex health systems changes.
Nearly four years into the launch of Guinea’s National Community Health Policy, Guinea’s Directorate of Community Health and Traditional Medicine and its partners recognize that this is an opportune moment to use iterative learning and adapting to improve rollout of the policy. Although the pilot program of the new policy and scale up has been successful in many facets, key stakeholders report certain challenges with the implementation of the policy, including the need for sustainable financing for communes, weak local governance, and poor transfer of skills and capacity building at the decentralized levels. However, these challenges have not been systematically reviewed across the country. The Accelerator will carry out this implementation research to help key policy and decision makers, as well as key community health actors, better understand the barriers and opportunities in an effective implementation of the National Community Health Policy.
The Accelerator is working in partnership with the University Gamal Abdel Nasser of Conakry and the Centre National de Formation et de Recherche en Santé Rurale de Maferinyah (Maferinyah Center for Training and Research in Rural Health), based in Guinea, for the design and implementation of this activity. The activity is designed with a decision space approach, which refers to careful mapping of decisional authority and capacity at decentralized levels of government and the health system. In close collaboration with USAID, and the Directorate of Community Health in the MoH in Guinea, the Accelerator will carry out this implementation research study in four of the seven regions of Guinea, conducting a sequenced data collection, consisting of a quantitative survey followed by qualitative in-depth interviews and focus group discussions.
Data collection for this activity will begin the Summer 2021. The results and recommendations that emerge from this implementation research, which are projected to be finalized and disseminated in Fall 2021, will be used to:
- Inform decision-makers in the health sector and beyond on the need to readapt the program for its improved efficacy.
- Target capacity-strengthening efforts to actors at different levels of the health systems and in different implementation regions.
- Highlight bottom-up and top-down accountability issues for improving responsiveness of the community health program to communities’ needs.