SIERRA LEONE: Employing SALT approach to prevent disease outbreak in border communities

By Ahmed Sahid Nasralla (De Monk)

A five-day special training of trainers on the SALT approach was conducted
at the GIZ office to prepare and equip field staff

Sierra Leone shares more than 50 porous border crossing points with neighbouring Liberia and Guinea, most of which are walkable distances. So it was naturally easy for the decade-long rebel war to spill over from Liberia in 1991 and the dreaded Ebola disease to spread from Guinea in 2014. And the entry point for both calamities was Kailahun District, Eastern Sierra Leone.

The health system in border communities in Kailahun District, as with other remote communities in Sierra Leone, is challenged with lack of capacity, resources and health personnel. Unmonitored border exchanges sometimes come with social problems, including the easy spread of communicable diseases. Poor surveillance system in these communities is also a challenge and relationship building is not flowing because of gaps within the health system.

To overcome these challenges in remote border communities in Kailahun, the Ministry of Health and Sanitation in collaboration with the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ) are supporting the District Health Management Team (DHMT) in Kailahun to implement the project called ‘Community Empowerment to Participate in Service Delivery’ within communities using the SALT approach. The SALT approach (Stimulate and Strengthen, Appreciate, Listen and Learn and Transfer what you have learnt) basically targets mindsets of community people and reinforces their roles and responsibilities with regards to their health systems.

 (A) Shows the connections between Gueckedou, where the outbreak started and all other districts in the region using a gravity model. Freetown is included to highlight the different strengths of connections that result from the pull of a large city. (B) Shows second degree adjacent districts. (C) Shows the total distribution of cases as of March 17th, 2016. Blue indicates areas with no cases. Photo credit: Scientific Report

The DHMT in Kailahun, is implementing the project with SEND Sierra Leone as key partner, based on the latter’s wealth of experience working on health related projects in the embattled district in the past decade. The project is targeting seven (7) chiefdoms in Kailahun district and thirty-two (32) remote communities in the border areas.

“We believe that if we capacitate and improve on the surveillance system in these communities, they will be able to take ownership and respond to some of the health and social issues that may arise. By so doing we have the vision to support the DHMT in building up a resilient health system to detect together early enough severe epidemic diseases, so that people can live a better life,” said Steven S. Bundor, SEND Sierra Leone Program Officer, Kailahun District.

He added: “Our approach is very clear and so we believe we can be able to have sustainable achievement because we are engaging the community people to raise awareness on health issues around them that prevent development.”

The SALT approach recognizes that communities have capacities to cope with adversity and can take steps to improve their health, however difficult their situation may be. It is rooted in the belief that enabling communities participate in health design, planning, and management leads to increased ownership, accountability and impact, and is arguably the best way to bring about changes for improved health service delivery.

The approach draws on a wide range of participatory learning and action techniques and tools that are designed to channel participants’ ideas and efforts into a structured process of analysis, learning, and action planning, with the overall aim of addressing communities’ health challenges and enabling them take their own initiatives to improve health service delivery.

A five-day special training of trainers on the SALT approach was conducted at the GIZ office from 20th May- 26th May 2019 to prepare and equip field staff, who will be directly involved in the implementation of the project in the communities, with the requisite skills and knowledge.

Participants were from the Ministry of Health and Sanitation and staff from SEND Sierra Leone as well as from the Christian Health Association of Sierra Leone (CHASL) working in Kailahun District.

According to one of the trainers, Ute Papkalla from the German Institute for Medical Mission e. V. – Difäm, the SALT methodology tries to help communities to reflect on their own strength, assets, and resources and use them for improvement of their own situations. She said it will also make them more independent from external help and make them more the drivers in their path towards better health. 

The methodology has a number of instruments developed out of experiences in Malawi, which started there about 8 years ago with the first project, and carried on in Guinea. All Projects were working on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ).

“From these experiences we continue developing the instruments that are being used and we expect the trainers to go into communities and select community facilitators who themselves will be trained. Those community facilitators are usually not so much educated but should be able to respond to certain criteria. For example, they should be acknowledged by the community, respected and be able to speak well. They are supposed to be the persons who will help their communities in thinking about their strength and deciding what actions they can take by their own means,” she explained.

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