Success and Sustainability of Health Facility Management Committees in Sierra Leone Using Human-Centered Design

In February 2017, the Advancing Partners & Communities project applied a human-centered design (HCD) approach, an engaging, participatory process that emphasizes mutual understanding, creative brainstorming, and collaborative problem-solving, to help ensure the success and sustainability of community facility management committees (FMCs) in Sierra Leone.

Community members who use the Rosengbeh health facility in Tonkolili come together to share their FMC’s experiences.

Since January 2016, in partnership with Sierra Leone’s Ministry of Health and Sanitation (MOHS), the Advancing Partners & Communities project has developed and implemented a community engagement strategy and toolkit to establish and strengthen FMCs linked to over 200 facilities in the project’s five districts. FMCs include selected community members and leaders who support the operation and maintenance of primary health care facilities on a voluntary basis. FMC responsibilities include holding monthly meetings, overseeing facility maintenance, soliciting community feedback on health facility quality, and implementing facility improvement action plans.

In an effort to ensure FMC sustainability, Advancing Partners & Communities worked with an HCD firm, Matchboxology, to engage over 100 people from all levels of the health system in a series of interviews and a participatory workshop. Stakeholders included MOHS directors; district health management team members; NGO partners; health facility staff; FMC members; community health workers; local and religious leaders; and community members, including pregnant and lactating mothers, youth, and Ebola survivors.

The HCD approach framed FMC success and sustainability as a human issue rather than a systems issue, encouraging stakeholders to express their personal experiences and insights. Key themes that emerged during the interviews included the need for sustained support for FMCs through refresher trainings and supportive supervision, the importance of trust between all actors at the community and facility levels, and the need to create an FMC fund to finance facility maintenance and improvements.

Workshop activities challenged participants to think about FMC issues from the perspectives of different health system actors.

The workshop gave stakeholders from the community level the opportunity to collaboratively identify the barriers and solutions for long-term FMC success. Activities included real-life problem-solving; empathy-building scenarios; and creatively brainstorming ideas about how FMCs might achieve specific results, such as improving family planning uptake.

Participants expressed appreciation for the participatory design of the workshop, which allowed them to work in a group setting with people from different backgrounds and share their experiences and suggestions for improving FMCs.

Dr. Santigie Sesay, Director of Reproductive and Child Health at the MOHS expressed, “What I’ve seen this morning is really wonderful. I’ve seen some very good participation between the community and the health care provider. [That] kind of collaboration between the two parties is very, very important.”

Advancing Partners & Communities will use the findings and results from these HCD-informed activities to fine-tune the FMC strategy and FMC toolkit, and to identify concrete recommendations and guidelines for the MOHS and its partners. These actions will help ensure FMC success and sustainability across Sierra Leone in the years to come.