Sierra Leone has one of the highest maternal mortality rates in the world with 1,165 deaths per 100000 live births (DHS, 2013). Healthcare services are overstretched with 1 health worker to 5,319 people (WHO, 2010) – underscoring the rickety nature of the health system. The country ranks last or near it – in many measures of well-being among more than 160 countries monitored by the World Bank and World Health Organisation. Most of the key aspects of disease prevention and control in the health system are non-existent leaving the whole population vulnerable to any disease outbreak. The sector is grossly underfunded, poorly equipped and beset with many structural problems – low remunerations for healthcare workers, technically under-resourced with medical-experts to deal with severe health emergencies such as disease outbreaks.

In view of the above, FOCUS 1000 sets up Kombra Network structures such as Religious Leaders, Market Women, Traditional Healers, the media, CSOs, community leaders, youth groups and women’s groups to undertake a range of actions to address the above issues in communities across the country.

Their engagment ensure the following – to coordinate and build synergies with other health systems strengthening structures at the district and community levels (Village development Committees, Facility Management Committees, Mother-to-Mother Support Groups etc.), Provide leadership in health messaging and engagements for the structures, raise awareness of community members, mobilize communities and engage stakeholders at the district and community levels to tackle key health burdens – maternal and infant mortality – raise awareness to increase health services uptake in communities, promote immunization, proper use of bed nets etc.

Given that these structures already exist at the district and community levels, there are key and specific areas Kombra Network can leverage to strengthen these structures, promote the visibility and recognition of FOCUS 1000 as a leading health systems strengthening NGO in Sierra Leone and harmonize specific aspects of the daily health messaging campaigns in the various districts for consistency and one based on evidence-based data – the DHIS system data reports on districts. These structures are embedded in the communities and they continue to be instrumental in efforts to increase uptake of health services, community mobilisation and actions to improve community health outcomes.

Functionalities of Structures and Kombra Network Entry Points

Village Development Committees: Community structures of key stakeholders at the community level comprising community leaders (chiefs, youth leaders, women’s leaders, religious leaders etc.) and their key functions include coordination of planned interventions or actions, awareness raising, community participation and ensuring accountability in the implementation of programmes at the community level. Based on these functions, Kombra Network can work with VDCs to recruit community participants at the chiefdom levels to promote community participation and involvement in all community engagement interventions. Also, though VDCs raise community awareness on health outcomes but there is lack of clarity whether the messages are targeted and driven by evidence-based data – that is, engaging community members to address the health issues of the day.

Mother to Mother Support Groups: Community structures of women with influence and clout at the community level and key utilities involve providing individual or direct counselling, information support on health related messaging and discussion forum for women to practice exclusive breastfeeding and effective child care. Again, Kombra Network can support the health messaging aspect of their function to increase messaging relevance and ensure that health messages are evidence-based – that is, predicated on the existing health challenges emerging from the districts and chiefdoms via the DHIS system.

Community Health Workers (CHWs): Trained community health representatives working in their communities to promote and create connection between community members and healthcare systems, increasing information on community health needs to health system providers and stakeholders and undertaking informal counselling, health screening and referrals. Given that the number of CHWs attached to catchment areas is scant (2 CHWs per catchment area), Kombra Network can directly support CHWs in routine health campaigns by providing more hands to engage communities – to increase health services uptake and increase the coverage of targeted health messaging in communities across the districts.

Facility Management Committees: Facility level structures in communities responsible for improving the quality and use of health services, supervision and control of facility funds allocated, increase facility responsiveness to localized needs and enhance community awareness of available healthcare services. Based on their functions, this structure plays a critical role in informing communities about the availability of health services and drugs but there is a main weakness – they are overly concentrated in the monitoring of allocated funds to facilities and in the process faltering on the delivery of other key functions such as informing communities about health services to maximize uptake. Kombra Network can coordinate with this structure and support efforts to increase community uptake of health services by proving useful info on the availability of health services.

Specific Objectives for Kombra Network

Against this backdrop, the network specifically undertake the following actions to support existing community structures to ensure synergies in all health related community engagements, messaging and awareness raising campaigns and coordination of actions to ensure consistency.
1. Work with structures to ensure health messaging and awareness raising is based on evidence-based or verifiable data sourced form data entry points.
2. Ensure consistency in health messaging across all the districts.
3. Establish working Kombra Network executives at the district and chiefdom levels with clear lines of responsibilities and reporting.
4. Commence holding meetings with all the community structures invited – to build trust, coordinate well and participate on all up-coming health engagements.
5. Support visibility of FOCUS 1000 in communities by supporting these structures with IECs – wrist bands, T-shirts, posters etc. – in the process promoting messaging consistency and visibility.
6. Hold monthly coordination meetings with these structures attending – and present key health data outcomes for the month to partners – to ensure that all engagements and awareness raising campaigns are reflective of the health realities of the various areas.
7. Map all existing structures of mosques, churches and other community structures to establish networks at the chiefdom level.