Barriers to Fully Funding a Community Health Workers (CHW) Program in Sierra Leone
Sierra Leone’s Community Health Worker (CHW) program has expanded primary health care access in line with regional commitments to strengthen community health systems. However,
the platform remains heavily dependent on external financing. A 2023 national investment case estimates the total program cost at US$53.7 million over 2021–2026, with a 57% funding gap of
approximately US$30 million currently unmet by committed sources. As global and regional partners increasingly emphasize domestic sustainability and country ownership of CHW
programs, understanding barriers to transition is increasingly urgent. This study employs a convergent mixed methods design, combining 13 key informant interviews across national, district, and local government levels with quantitative data from the 2023 Sierra Leone CHW Investment Case (MOMENTUM Country and Global Leadership 2023), a publicly available nationally commissioned report; primary data are 13 KIIs conducted by the author across five stakeholder categories.
Students submitted photos and reflections as part of their thesis research. All the people in the photos gave permission for their photos to be taken and shared.
