What barriers might hinder the success of your project and how do you plan to overcome them?
Internally, we must continue to ensure that those who bear the brunt of the suffering in Liberia remain the primary vision-setters, especially as we engage more advisers, funders, and stakeholders. The success of our community-based strategy depends on preserving these roots. We will incorporate within our strategic plan clear commitments to equitable decision-making and strong local leadership development.
Looking outward, our long-term success will be more likely with changes to government policy. While the government recognizes CHWs as an essential component of reconstructing post-conflict health care, the ways to best incorporate them remain unclear. Experts disagree, for instance, with giving CHW salaries and added responsibility (and concomitant management and training support).
In response, TH has pushed for a more progressive CHW policy using research and advocacy to demonstrate the extraordinary value of a well-paid, highly trained CHW with better management systems. Based our published work demonstrating 60% increased survival among HIV patients supported by a CHW, in 2010 the Ministry of Health circumvented its own policy, authorizing scale-up of a paid, well-trained CHW pilot at several additional public treatment sites.
Tell us about your partnerships
Liberian Ministry of Health & Social Welfare (MoHSW): Through the Health Sector Pool Fund, the MoHSW finances the facility-level delivery of the Basic Package of Health Services at 17 public health clinics, where TH’s CHWs refer patients and receive direct supervision. The Pool Fund also finances the training workshops of CHWs in HIV, tuberculosis, mental health, and maternal and child health.
Global Fund for AIDS, Tuberculosis, and Malaria: The Global Fund has made a fraction of the investment necessary to scale our model to 17 national HIV treatment sites around the country. Currently, the Global Fund grant provides approximately $100,000 annually to support the stipends of 95 CHWs -- all of them people living with HIV/AIDS -- to provide home-based care to other patients with HIV/AIDS.
Partners In Health (PIH): Through our partnership with Partners In Health and advising from Drs. Paul Farmer, Joia Mukherjee and other programmatic staff, TH has benefited from technical assistance, strategic guidance on its CHW curriculum, strategy, and planning since 2007.
UN Refugee Agency (UNHCR): UNHCR provides limited funding support for administrative costs associated with the project as well as in-kind loan of TH’s only vehicle.
Merlin: Merlin is TH’s primary partner on the MoH’s Pool Fund project. Since 2006, TH and Merlin have partnered to support health services in Grand Gedeh County. Forming part of a model collaboration between an INGO (Merlin), a local NGO (Tiyatien) and the Liberian government (Ministry of Health), Merlin provides logistical, administrative and capacity building support to local partners, including TH.
Explain your selections
Since our origins, TH’s innovative work has depended heavily on bold individuals and foundations who are willing to invest in programs typically denied by traditional policymakers and funders. Indeed, our unconventional model was launched out of a suitcase of donations from Dr. Panjabi’s wedding.
Today, this approach continues in our current strategy, which focuses primarily on growing communities of individual donors in Boston, New York, and Chapel Hill through a combination of online giving, social media, and community events hosted in supporters’ living rooms. Additionally, early investments from family foundations and social innovation prizes, including Echoing Green and the Rainer Arnhold Fellows program have support TH's initial growth.
Furthermore, in Liberia, we have persuaded the Liberian government to invest over $400,000 in rehabilitating public clinics in Grand Gedeh, partly covering administrative and support systems for our CHW pilot.
By 2015, we see governmental and multilateral grants providing 60% of our revenue. The remaining funds required for continued innovation and new interventions will come from US corporations/foundations (20%), major gifts (10%), and grassroots support (10%).
How do you plan to strengthen your project in the next three years?
TH will continue to strengthen its project through continued development and expansion of CHWs knowledge and skill base through longitudinal training and clinic-based support, while expanding its work to more rural communities in Grand Gedeh County through a community-based model of care. Furthermore, TH will continue to develop and utilize rigorous monitoring and evaluation systems to track progress and success, with the intention of continually reflecting upon and improving systems, as well as disseminating findings for further strengthening of rural health care systems in post-conflict areas. Continued and expanded partnership with the Ministry of Health will help TH strengthen our project in working towards a model for national scale-up.