In 2010, at the same time as the national roll
out of the Free Health Care Initiative (FHCI), which
removed user fees for facility based health care, trained
community health volunteers (CHVs) were deployed to
provide integrated community case management of diarrhea,
malaria and pneumonia to children under 5 years of
age (U5) in Kambia and Pujehun districts, Sierra Leone.
After 2 years of implementation and in the context of
FHCI, CHV utilization rate was 14.0 %. In this study, we
examine the factors associated with this level of CHV
utilization. A cross-sectional household-cluster survey of
1590 caregivers of 2279 children U5 was conducted in
2012; with CHV utilization assessed using a multiple
logistic regression model. Focus groups and in-depth
interviews were also conducted to understand communities’
experiences with CHVs. Children with diarrhea
(OR = 3.17, 95 % CI: 1.17–8.60), from female-headed
households (OR = 4.55, 95 % CI: 1.88–11.00), and whose
caregivers reported poor quality of care as a barrier to
facility care-seeking (OR = 8.53, 95 % CI: 3.13–23.16)
were more likely to receive treatment from a CHV. Despite
low utilization, caregivers were highly familiar and
appreciative of CHVs, but were concerned about the lack
of financial remuneration for CHVs. CHVs remained an
important source of care for children from female-headed
households and whose caregivers reported poor quality of
care at health facilities. CHVs are an important strategy for
certain populations even when facility utilization is high or
when facility services are compromised, as has happened
with the recent Ebola epidemic in Sierra Leone.