CHOs And CHAs Should Be Regulated

An Op-Ed By CHO Aruna Wunda

Diaspora Liaison Office, Sierra Leone Association of Community Health Officers (SLACHO)

August 31, 2020

The Community Health Officers (CHOs) and Community Health Assistants (CHAs) provide about 70 to 75% of all health care service delivery in Sierra Leone especially in the provinces.

Presently, there are more than 2,000 CHOs and CHAs across the country who work 24 hours to keep the general population healthy in the MOHS and other health related partners. These CHOs and CHAs work and supervise more than 1,200 Peripheral Health Units (PHUs) including Western Urban and Rural areas operating under the Ministry of Health and Sanitation (MoHS). CHOs and CHAs serve as the primary health care providers in all the 16 districts across the country. They demonstrate a high commitment and selflessness in providing community health care to the deprived communities.

They support the district primary health care units consisting of Community Health Centers (CHC), Community Health Posts (CHP) and Maternal and Child Health Posts (MCHP). In addition, these CHOs and CHAs provide all aspects of primary health care to these deprived and hard-to-reach communities including: minor surgical procedures, diagnose and treat minor and major illnesses, and up-referral of complicated and emergency cases to district hospitals or specialists.

The CHOs and CHAs plan, implement and evaluate the activities and the resources of both the primary and secondary heath care. They also collect, analyze, organize health related data from the communities for better planning and decision making. Furthermore, there are presently Surgical CHOs that are attached to all the referral and district hospitals across the country to perform surgical procedures with or without physician surgeon supervision. The cadre also has Ophthalmic, Nutrition, Surveillance, administrative, and Mental Health CHOs in both the Government and reputable Local and International Non-Governmental Organizations who perform very well in their various expertise.

As a professional cadre, it is a complete embarrassment and a disappointment to perform all the above functions without license and regulatory board. The Sierra Leone Association of Community Health Officers (SLACHO) has engaged successive Governments including the present government to pass the “The Community Health Practitioners Act, 2017” as ratified into law to enable the CHOs and CHAs to practice with a professional license and have a regulatory body to provide checks and balances to its membership.

One can agree with me that it sounds ironical that a professional cadre is pressurizing the Government to provide license and a board to regulate its activities. If the CHOs are the head of the Chiefdom Health Care delivery system, and are the second in the clinical organogram in the Ministry of Health; they supervise all the other cadres in the Ministry with the exception of Medical Doctors; such as the State Enrolment Community Health Nurses (SECHN), Community Midwives, Laboratory Technicians, and Maternal and Child Health Assistant nurses (MCH-As) of which all are licensed and have a regulatory board but not the CHOs.

Is not the Government’s responsibility to protect its citizens from medical errors, malpractices and professional misconducts? Why should a professional cadre beg a responsible Government to be regulated or have a license? If the CHOs and CHAs can do an invasive technique, do surgical procedures including cesarean sections; they provide all the health care services to the vulnerable population including the disables, the destitute, the deprived and even the deceased in the hard-to-reach communities; are they not supposed to be licensed and be regulated? Are the CHOs and CHAs asking for too much?

The CHOs and CHAs have right to be licensed and have their own regulatory board as was proposed in a meeting with other medical professional bodies at the MOHS Conference Hall, for an effective and efficient health service delivery in Sierra Leone.

The SLACHO body is asking this Government to sign into law the Community Health Practitioners, Act of 2017 that was ratified by the previous Parliament but stocked at the table of the former President. This cadre continues to feel demoralized and unrecognized with no foreseeable hope for their self-sacrifices and relentless efforts in working in remote communities with no social amenities such as: light, internet, mobile coverages, safe drinking water and good roads.

Similarly, this cadre has also suffered incessant marginalization in the hands of the Ministry of Health and Sanitation for its explicit bias. For instance, the CHO unit is the only cadre that has no clear defined wing and role in the Ministry of Health and Sanitation (MoHS) organogram. For over 30 years, the proposed scheme of service for senior CHOs and newly graduated CHOs and CHAs has not been implemented despite the mounting of pressure from SLACHO.

The Ministry’s continuous act to deliberately fail to recognize SLACHO in all their press releases, journals and public health documents is appalling and continues to plague this cadre, as it was in the case of the recent health workers’ Insurance Scheme where CHOs were not mentioned among the health workers.

It is in this limelight that SLACHO is calling on the Government and His Excellency the President of Sierra Leone to assent his signature on the Community Health Practitioner Act of 2017 to put the CHOs and CHAs in line with the national and international best practices. If this Bill is signed into law, the CHOs and CHAs will have a regulatory body that will hold its members accountable for any professional misconduct or any medical malpractice.

Finally, because the CHOs are professionals (medical professionals can best regulate themselves) with identifiable people of knowledge and expertise, trained from a recognized tertiary institution with a well-defined job description different from the other cadres, the SLACHO does not want the Community Health Practitioners Act to be amalgamated or incorporated with any other medical professional Act. The CHOs and CHAs should be treated independently just as those other medical cadres in the Ministry of Health and Sanitation.