Community health workers role in combating public health emergencies: lessons from Sierra Leone

Sierra Leone has faced numerous devastating health crises over the past decade, including the Ebola epidemic (2014–2016), the COVID-19 pandemic (2020–2022), and the ongoing mpox outbreak declared on January 10, 2025. These emergencies have exposed the fragility of the healthcare system. Community Health Workers (CHWs) have become indispensable in addressing these challenges, particularly in underserved and remote areas. This commentary highlights the crucial role played by CHWs in bridging healthcare gaps during public health emergencies, and challenges encountered. It also proposes recommendations to enhance their impact in bolstering the Sierra Leone healthcare system. Since Sierra Leone established CHW as a health workforce in 2012, they have played vital roles in outbreak response, including contact tracing, public awareness campaigns, disease surveillance, and ensuring the continuity of care for non-emergency services. Their contributions during health crises, such as breaking disease transmission chains during the COVID-19 pandemic and promoting social mobilization during the mpox outbreak, underscore their central role in building a resilient health system. Despite their importance, CHWs face significant challenges that hinder their effectiveness. These include insufficient training opportunities, inadequate resources such as protective equipment and medical supplies, lack of formal integration into national health systems, and irregular or insufficient remuneration. Addressing these barriers is essential to optimize their impact and sustain their contributions to health system resilience. Key strategies include providing regular training and mentorship, equipping CHWs with essential resources, integrating them into national emergency response plans, and ensuring timely and equitable compensation. The role of CHWs in Sierra Leone offers critical lessons for low- and middle-income countries struggling with healthcare worker shortages. Investing in CHWs enhances emergency preparedness and also strengthens health systems, improves healthcare accessibility, and advances progress toward Sustainable Development Goal 3. Recognizing CHWs as a cornerstone of outbreak response is essential to building resilient and equitable healthcare systems worldwide.