It's already midday; Evelyn Kpaanquoi has completed her routine visits to the families of Zortapa Town in Liberia's Nimba County. She starts early to catch local parents at home before they head into the fields for the day's work.
As one of the three community health assistants (CHAs), it's her job to make sure that children are checked for malaria, pneumonia, diarrhea, and malnutrition. If a child is sick, she either administers free drugs or makes a referral to the nearest clinic.
Before 2017, her life, like those of her parents and neighbors, was centered on farming. She stepped into her current role, serving her community of 83 households.
"It can be hard, but we have to do it for our people," she said."
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Launched in 2016 after the deadly Ebola epidemic, the community health assistants program was designed to bridge the gap in healthcare delivery for underprivileged and hard-to-reach areas like Zortapa Town.
By 2020, more than 3,400 CHAs had been trained, deployed and incentivised to provide health services to rural Liberians living more than one hour, or 5 km, from the nearest health facility.
"The people depend on us," said Kpaanquoi. The distances are far so everyone here looks up to us."
According to the revised National Community Health policy published in 2025, CHAs had, in less than a decade, treated over 700,000 cases of malaria, diarrhea, and pneumonia. They had conducted more than 800,000 malnutrition screenings and made more than 5.4 million home visits.
They are recruited by their communities and presented to the county health authorities to work as CHAs. Despite their efforts, their stipends and drug supplies mainly depend on donor-supported projects such as the World Bank, the Global Fund, and, formerly, USAID.
Previous projects funded by the World Bank and USAID projects in Bong, Lofa, River Gee, Grand Kru, Grand Gedeh, Grand Cape Mount, Gbarpolu, and Grand Bassa, which are non-functional, have reportedly led to CHAs quitting.
Liberia's community health program has hugely relied on external funding support. Stakeholders and NGOs working in community health service delivery are calling on the government to take full ownership of funding responsibilities.
Funding for the program--including both medical supplies and staff compensation--has relied entirely on the support of international non-profits.
As donor institutions scale down funding, many are worried about the sustainability of the programs that have served communities.
The $125 million U.S.-Liberia global health agreement, which targets HIV/AIDS, malaria, and maternal and child health, notably omitted support for community health workers. This oversight became a primary point of contention during a recent dialogue in Monrovia, where Liberian civil society organizations raised alarms that the lack of funding for these frontline workers could jeopardize vital immunization and vaccine delivery efforts.
CHAs are already feeling the pinch.
Junior Warkar, CHA in Zor-Kialay town in Karnplay City, Nimba County, faced delayed payment of the stipend is only part of his struggles. He also grapples with limited medication.
As the only CHA operating here, Warkar's population has grown over the years, now totaling 1,494, a figure above the 200 to 350 (40 to 60 households) set up in the national community health policy.
"I serve some people, and some people don't get it," he says.
Currently, the Global Fund Circle Seven grant, an $117,546,670 fund, supports community health assistants (CHAs) across six counties: Montserrado, Bomi, Nimba, Sinoe, Maryland, and Margibi.
In Rivercess County, Last Mile Health provides targeted support to both CHAs and community health services supervisors (CHSSs) in Rivercess County, equipping them with essential resources such as mobile devices, motorbikes, backpacks, flashlights, and fuel.
William E. Walker Jr., Head of the Liberia Coordinating Mechanism Secretariat for the Global Fund Grant, warned that the closure of donor institutions and the suspension of support for community health workers threaten the future of programs that have long served rural communities.
"Many donors are on the verge of scaling down funding. We are now asking the government to take on sustainability," he said.
According to him, for community health programs to remain functional, CHAs must receive their incentives, necessary supplies, and consistent supportive supervision.
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"So, part of the Global Fund mandate to Liberia is to sustain what is already in existence, and all of these gaps that are identified should be taken on by the government."
The Ministry of Health did not respond to the interview request. Despite several follow-ups regarding the letter sent to Minister Dr. Louise Mapleh Kpoto, this reporter was repeatedly informed that the request was still pending on the minister's desk.
Despite Walker's claim that the Global Fund supports CHAs in six counties, including Nimba, Kpaanquoi and Warkar complained that they have not received their monthly stipends since the beginning of 2026. They also cited shortages of drugs and medical supplies.
Explaining the payment delays, Walker said that the program was previously implemented through Plan International through December 2025. Following the expiration of that partnership, the program transitioned to Catholic Relief Services (CRS). "There have been some delays in finalizing the MOU between Catholic Relief Services and the Ministry of Health," Walker stated. "Once the MoU is finalized, CHAs will start receiving their stipend."
