Changing power narratives: an exemplar case study on the professionalisation of community health workers in Liberia.

Despite their central role in achieving health equity and Universal Health Coverage, only a minority of community health workers (CHWs) is formally recognised as health workforce and receives a salary. Community health policies are formed within the power dynamics of global health practice. We argue that critical investigations of the power dynamics that influence the design of CHW programmes can contribute system-level insights to strengthen their roles.

Under-five mortality before and after implementation of the Liberia National Community Health Assistant (NCHA) program: A study protocol.

Between 2018 and 2022 the Liberian Government implemented the National Community Health Assistant (NCHA) program to improve provision of maternal and child health care to underserved rural areas of the country. Whereas the contributions of this and similar community health worker (CHW) based healthcare programs have been associated with improved process measures, the impact of a governmental CHW program at scale on child mortality has not been fully established. We will conduct a cluster sampled, community-based survey with landmark event calendars to retrospectively assess child births and deaths among all children born to women in the Grand Bassa District of Liberia.

A repeated cross-sectional study of the association of community health worker intervention with the maternal continuum of care in rural Liberian communities.

Background: The maternal continuum of care (CoC) (antenatal care, facility-based delivery, postnatal care) is critical to maternal and neonatal health and reducing mortality, but completion in rural areas of low- and middle-income countries is often limited. We used repeated cross-sectional household surveys from a rural Liberian county to explore changes in rates of completion of all steps and no steps in the maternal CoC after implementation of the National Community Health Assistant Program (NCHAP), a community health worker (CHW) intervention designed to increase care uptake for families over five kilometers from a facility.

Methods: We analyzed repeated cross-sectional household surveys of women aged 18-49 served by NCHAP in Rivercess County, Liberia.

Measuring health system responsiveness in a national community health worker primary care programme in rural Liberia.

As many low- and middle-income countries scale up community health worker (CHW) programmes to achieve universal health coverage, ensuring quality as well as access is critical. Health system responsiveness (HSR) is a core domain of quality patient-centred care but has not been widely measured in CHW-delivered care. We report results from a household survey measuring HSR and health systems' quality of CHW-delivered care in two Liberian counties where the national CHW programme of Community Health Assistants (CHAs) for communities ≥5 km from a health centre has been implemented.

Impact of the Liberian National Community Health Assistant Program on childhood illness care in Grand Bassa County, Liberia.

Liberia launched its National Community Health Assistant Program in 2016, which seeks to ensure that all people living 5 kilometers or farther from a health facility have access to trained, supplied, supervised, and paid community health workers (CHWs). This study aims to evaluate the impact of the national program following implementation in Grand Bassa County in 2018 using data from population-based surveys that included information on 1291 illness episodes. We measured before-to-after changes in care for childhood illness by qualified providers in a portion of the county that implemented in a first phase compared to those which had not yet implemented.

Examining the gender imbalance in the National Community Health Assistant Programme in Liberia: a qualitative analysis of policy and Programme implementation.

The Revised National Community Health Services Policy (2016-2021) (RNCHSP) and its programme implementation, the Liberian National Community Health Assistant Programme (NCHAP), exhibit a critical gender imbalance among the Community Health Assistants (CHAs) as only 17% are women. This study was designed to assess the gender responsiveness of the RNCHSP and its programme implementation in five counties across Liberia to identify opportunities to improve gender equity in the programme. Using qualitative methods, 16 semi-structured interviews were conducted with policymakers and 32 with CHAs, other members of the community health workforce and community members.

Liberia's First Health Workforce Program Strategy: Reflections and Lessons Learned.

Following civil war and the Ebola epidemic, Liberia's health workforce was devastated, essential health services and primary care were disrupted, and health outcomes for maternal and child mortality were amongst the worst in the world. To reverse these trends, the government of Liberia developed the . With the goal of building a resilient and responsive health system to ensure access to essential services and the ability to respond to future crises, this strategy aimed to add 6,000 new professionals to the workforce.

Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative.

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries.

A novel personal protective equipment coverall was rated higher than standard Ebola virus personal protective equipment in terms of comfort, mobility and perception of safety when tested by health care workers in Liberia and in a United States biocontainment unit.

Background: During the 2014-2016 Ebola virus epidemic, more than 500 health care workers (HCWs) died in spite of the use of personal protective equipment (PPE). The Johns Hopkins University Center for Bioengineering Innovation and Design (CBID) and Jhpiego, an international nongovernmental organization affiliate of Johns Hopkins, collaborated to create new PPE to improve the ease of the doffing process.

Methods: HCWs in Liberia and a US biocontainment unit compared standard Médecins Sans Frontière PPE (PPE A) with the new PPE (PPE B).

Continuous professional development of Liberia's midwifery workforce-A coordinated multi-stakeholder approach.

Background: Maternal and newborn mortality remains high in Liberia. There is a severe rural-urban gap in accessibility to health care services. A competent midwifery workforce is able to meet the needs of mothers and newborns.

Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia.

Background: A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated.