Liberia's national community health program went from dispersed pilots to nationwide scale within 4 years. n A network of policy entrepreneurs from the Liberian government, donors, and implementing partners capitalized on several windows of opportunity to achieve this success. * First, they seized the evidence from a series of pilot projects and-during a point of significant global momentum around community health-evaluated the agenda. * Second, they leveraged the impact of the community health workers during the Ebola virus disease outbreak to propel forward a consolidated, paid cadre with significant political and financial backing. n Policy makers and program managers should consider coalition building and identifying diverse champions as an essential ingredient for impacting large-scale change, even in the face of significant challenges. n Liberia's community health program is bolstered by significant research and evidence. However, the policy entrepreneurs who brought the community leaders, Government of Liberia stakeholders, donors, and partners around the table to buy into a common program has been the "secret sauce" of the program's success.

The Revised National Community Health Services Policy (2016-2021) (RNCHSP) and its program implementation, the Liberian National Community Health Assistant Program (NCHAP), exhibit a critical gender imbalance among the Community Health Assistants (CHAs) as only 17% are women (MOH, 2016). This study was designed to assess the gender responsiveness of the RNCHSP and its program implementation in five counties across Liberia to identify opportunities to improve gender equity in the program. Using qualitative methods, 16 semi structured interviews were conducted with policymakers and 32 with CHAs, other members of the community health workforce and community members. The study found that despite the Government of Liberia’s intention to prioritise women in the recruitment and selection of CHAs, the planning and implementation of the RNCHSP were not gender responsive. While the role of community structures, such as Community Health Committees, in the nomination and selection of CHAs is central to community ownership of the program, unfavourable gender norms influenced women’s nomination to become CHAs. Cultural, social and religious perceptions and practices of gender created inequitable expectations that negatively influenced the recruitment of women CHAs. In particular, the education requirement for CHAs posed a significant barrier to women’s nomination and selection as CHAs, due to disparities in access to education for girls in Liberia. The inequitable gender balance of CHAs has impacted the accessibility, acceptability, and affordability of community healthcare services, particularly among women. Strengthening the gender responsiveness within the RNCHSP and its program implementation is key to fostering gender equity among the health workforce and strengthening a key pillar of the health system. Employing gender responsive policies and programs will likely increase the effectiveness of community healthcare services.