At the entrance of Ross Road Community Health Centre (CHC), a Peripheral Health Unit (PHU) in the East End of Freetown, Sierra Leone, stands a pedal-operated handwashing station. A clinic member of staff wearing a mask branded “Corona na wi all fet” (“Corona is our fight”) checks each visitor’s temperature with a thermometer.

All health care workers wear masks and strictly observe all Covid-19 (Corona Virus Disease 2019) health protocols. This has become the new normal at the Ross Road CHC during the pandemic. The woman at the helm of this CHC is Rose Patricia Stevens, a Community Health Officer (CHO) who joined Ross Road CHC four years ago.

Ross Road CHC is supported by the Western Area Urban District Health Management Team and the NGO Concern Worldwide, as part of the UNITE consortium under the Saving Lives in Sierra Leone (SLiSL) programme. SLiSL is a five-year programme funded by the UK Foreign and Commonwealth Development Office (FCDO), which aims to end the preventable deaths of mothers, adolescents and children in Sierra Leone, while building towards resilient universal health coverage.

On a quarterly basis the SLiSL programme conducts joint field visits to provide FCDO, the Ministry of Health and Sanitation (MoHS) and implementing partners with first-hand experience of relevant aspects of the health system, in order to deepen their contextual understanding. It is also an opportunity to pay direct attention to specific issues, such as maternal death surveillance and response (MDSR), supply chain, family planning, medical devices, and provide opportunities for brainstorming solutions to challenges and bottlenecks.

This joint visit was focused on maintenance of essential health services in the Western Urban District during COVID-19 pandemic and included a visit to Ross Road CHC. The Ross Road CHC was used a case to illustrate how essential health service delivery was affected at the PHU level. During this visit, Rose Stevens presented the CHC’s strategies to mitigate risks posed by Covid-19 while maintaining the delivery of routine health services.

At the start of the Covid-19 pandemic, the District Health Management Team (DHMT) Western Area Urban invited Rose and other health workers to attend sensitisation training at the DHMT headquarters in Cline Town. During the session, the health workers received information on appropriate Covid-19 health measures including the importance of handwashing and wearing masks. Health workers also received training on how to screen patients, encourage social distancing and use the Covid-19 emergency hotline (117) to report suspected cases.

The training helped Rose to implement efficient handwashing practices and mandatory wearing of face masks for all staff and patients at her CHC. At the CHC, there are strategically placed information, education and communication materials on handwashing methods and instructions on mask wearing. This has helped patients and staff to receive accurate information about staying safe during the pandemic.

The SLiSL clinical mentorship programme has also proven to be helpful in easing the burden of work on Rose. Mentors from the UNITE SLiSL consortium partners in Western Area Urban district (Concern Worldwide, Marie Stopes) visit the CHC regularly to provide targeted clinical mentorship and on-the-job training to staff.

These mentors help healthcare workers to strengthen their knowledge and skills on lifesaving reproductive, maternal, newborn, child and adolescent health (RMNCAH) competencies while integrating appropriate Covid-19 prevention measures.

Rose has faced significant challenges in running the clinic during the pandemic. For example, at the onset of the crisis many patients were reluctant to come to the CHC to access care as they were fearful that they might contract Covid-19. Rose decided to work with Community Health Workers (CHWs) to mobilise and sensitise the community by sharing accurate information about Covid-19 safety measures in place at Ross Road CHC. As community members within the catchment area of the CHC perceive CHWs as trusted bearers of information, this engagement strategy proved to be successful in increasing the patient volume over time for routine health services.

The CHC also faces several infrastructural challenges which impede routine service delivery. For example, Rose explains: “The incinerator at the clinic is broken, and it will be a challenge to get it repaired.” She pays SLL 10,000 (approximately USD 1) daily for the municipal waste management tricycle to collect waste at the clinic.

This is a financial burden as this money comes out of her own pocket and makes proper waste disposal at the CHC difficult. The CHC also struggles with an irregular power supply, so Rose buys LED lights to use during power outages in the evenings and at night when they are often conducting deliveries and attending to accident emergencies.

Despite these challenges, Rose oversees the CHC with fortitude and an optimistic can-do attitude. Supervising over 40 staff, she continues to support and mentor them on record-keeping and patient screening, while also overseeing all activities at the clinic, including consultations with patients.

A human interest story from the Monitoring, Evidence, Learning and Review (MELR) component of FCDO Saving Lives in Sierra Leone (SLiSL) and the UNITE consortium/ Concern World Wide

Read more about the Saving Lives in Sierra Leone (SLiSL) programme