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Sierra Leone’s Health Care System Overwhelmed as Demand for Free Health Care Exceeds Supply

Abdul R Thomas
Editor - The Sierra Leone Telegraph

3 May 2010

It is now six days since the President launched a free health care provision for lactating mothers, pregnant women and children under five years old. Already, there are signs of the nation’s crippling Health Service becoming overwhelmed, as demand far exceeds the supply of drugs, beds, nurses, doctors, and equipment. Is the nation’s Health Care Service in crisis?

In his speech marking the launch of this new programme, President Koroma proudly announced that; “From this Independence Day, every pregnant woman, breastfeeding mother and child under five years of age will be entitled to free health care in every Government health facility in the country. From pre-natal check-ups to surgical services, drugs, vaccinations and inpatient hospital care, no pregnant woman, breast feeding mother or child under five would have to pay a single Leone.”

Sierra Leone’s Health Care Service is facing the greatest challenge since its formation over fifty years ago. At the best of times, for the country’s population of over five million, it is a life and death struggle trying to access the available limited medical care, which is being rationed on a fee paying basis.

With an average daily income of less than 50 US Cents, many lives are being lost simply because of affordability. Poverty, poor medical infrastructures, and the appallingly skewed ratio of medical staff to patients, life expectancy is one of the lowest in the world.

Local cemeteries across the country bear witness to the high mortality rate of the country’s under forty-fives; the most economically active in the population. Local radios’ obituary announcement makes for very depressing listening, as the average age of most of the decease is no higher than 40 years old.

Hence, few in Sierra Leone would relish the thought of the country’s health care provision becoming politicised, nor would they want to see politicians play politics with their health and consequently their lives.

The Global Human Development Index puts Sierra Leone at the bottom of the scale – with one of the highest maternal and infant death rates in the world. One in eight women in the country die during pregnancy or childbirth; while one in twelve children do not live to see their first birthday.

President Koroma’s dream of a Sierra Leone that is devoid of such a poor image, had inevitably and quite rightly won the admiration of the people.

But it now seems that the good intentions of the government and their international partners, which includes; the Department for International Development (DFID), the United Nations Population Fund, UNICEF, the World Health Organisation and the World Bank, had not been matched with sound management planning. There are suspicions of a mad and unnecessary rush to meet an irrational deadline.

Some critics say that as with Bumbuna, the overriding goal for the speedy and hurriedly launch of the new free health care programme was political expediency, rather than systematically planning to address the genuine and desperate health needs of a dying nation.

What are the facts?

It is now understood that the government and their international partners had planned for the new health care provision to meet the demands of one million children and two hundred and thirty pregnant women. Was this target evidence-based?

Sierra Leone can only boast of five obstetricians and gynaecologists, seventy-five trained medical doctors, and eight hundred and twenty-five state registered nurses.

At the best of times the country’s medical staff struggle to cope with the ever rising demands of a sickly population. The launch of a free health care programme will inevitably put tremendous neck breaking strain on the Heath Service. There is one doctor for every 67,000 people.

Sierra Leone has an overwhelmingly large female population. In one of the chiefdoms alone - located in the south of the country – in the Moyamba District, with a population of over 3,000 people, over half the population is female – aged under 60 years old. This community has only one nurse serving the entire chiefdom.

Critics have warned that the continuous absence of a substantive Minister of Health will seriously affect the management and co-ordination of this huge national programme. The president appears to have personally taken direct control and supervision of the delivery of the Programme.

A budget of $80 Million has been set aside by the international community to meet the cost of delivering the free health care programme for a year. But the government has recently decided to increase the health sector salaries budget to $125 Million per annum, based on the promise by British Prime Minister Brown to provide additional funding.

"As you may have heard my Government has doubled the salaries of most health workers and increased salaries even more for our most skilled workers. By making this commitment, we the Government will pay the health workers so that the children and pregnant women of this nation don’t have this responsibility" – said President Koroma.

The government is pinning its hope of success on the skills and care of the country’s hard working health workers. President Koroma said: “We realise that the success of this policy depends on the skills and care of our hard working health professionals. For many years, previous Governments have not appreciated the vital contribution our health workers have made to the health of the nation. Our doctors and nurses have been underpaid and overworked.”

But there are reports that doctors and nurses are yet to receive the promised salary increase, which was granted them in settlement of the two weeks dispute that saw widespread walkouts. Is the government now reneging on its promise?

More hospital beds are needed. $10 Million spent on medicines in response to the anticipated demand is far from adequate. New clinics need to be built that will provide specialist maternal and paediatric care. Modern medical equipments are needed, with the trained personnel to use them.

This rise in the health sector wage bill, which was not previously budgeted for in the original plan for the delivery of the new programme, has sparked fears that the country will run out of money to continue its free access to health care programme. It also questions the rationale in whipping up growing expectations by offering free health care, at this point in the global economic cycle and Sierra Leone’s exclusive dependence on international Aid.

The current gap in funding for the country’s health sector is estimated at $20 Million. But critics say that this deficit will more than quadrupled by the end of the year, once the awareness raising programme for the free health care provision reaches every town and village in the country.

There are media reports of villagers from far afield as up north, travelling to the capital Freetown in search of their free medical entitlement. Expectations must now be managed, if the growing chaos caused by long queues forming outside hospitals and health centres across the country is to be controlled.

The commitment of health workers to ensuring the success of the programme cannot be denied. During the country wide sensitization visits by the Ministry of Health’s Chief Nursing Officer, she told reporters:

“I was delighted to leave each meeting knowing that each and every nurse is as committed as the government and its partners to delivering free health care into the future. And in return we are committed to ensuring our staff receive the right training and professional development and improved working conditions to help them deliver the health care Sierra Leoneans deserve.”

She also mentioned that; “about 1,500 nurses and health workers from across the country have showed their support for the programme.” President Koroma has received plenty of goodwill from the health workers and must take great care not to lose it. He must honour the salary increase that he promised the health professionals.

The international community and President Koroma have committed themselves to the delivery of a free access to health care programme that could benefit over 50% of the country’s population.It is now clear that for political expediency, they had thrown all caution to the wind, by setting aside the rigorous planning process that usually precede the development and delivery of such a huge national programme. The nation’s health service is now overwhelmed.

A new health crisis is beginning to emerge. Expectations have been raised far in excess of what the health infrastructure can deliver. There is no turning back now. It remains to be seen whether the programme can be sustained without the international community increasing their funding contributions.

But to echo the words of President Koroma: "Today, I want to reassure the Nation that I am determined to make this policy work." Will the international community continue to stand shoulder to shoulder with the President in the face of a looming crisis?


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