President Bio to spend World Bank’s $60 million grant on building sustainable healthcare and pay for Health Insurance scheme

Sierra Leone Telegraph: 3 April 2022:

Last December, the World Bank announced that it had approved $60 million grant financing to establish a project known as the Sierra Leone Quality Essential Health Services and Systems Support Project to provide maternal and child health services for two million people in the country.

According to the World Bank, the Sierra Leone Quality Essential Health Services and Systems Support Project is funded by a $40 million International Development Association (IDA) grant and $20 million grant from the Global Financing Facility (GFF) “to help the Government of Sierra Leone build resilient, efficient, and equitable health systems for expanding coverage and utilization of essential health services and to reduce diseases and mortality of Serra Leoneans.”

Making this announcement last December, said Abdu Muwonge, World Bank Country Manager for Sierra Leone said: “The World Bank is happy to support this operation through additional financing to the Ministry of Health and Sanitation as it continues to improve health services delivery in Sierra Leone by building on past projects to strengthen disease prevention, pandemic preparedness and response through an integrated approach at the district level,”  “It will help improve quality Essential Health Services (EHS) and increase utilization of health services and improve the health status of the population.”

The World Bank in its statement also said that “The Quality Essential Health Services and Systems Support project will support the implementation of an innovative approach to deliver health services at the district level, particularly for women and children Implemented through a Public Private Partnership. This approach arranges service delivery assets into a network consisting of an anchor health facility (hub), which offers a range of services, complemented by lower-level facilities (spokes) that offer limited services and refer patients who require more intensive services to the hub for treatment. The project will also invest in holistic primary health care systems focusing on equity, including upgrading infrastructure, equipment and supply of essential drugs and commodities, and improving health facility management to support among other outcomes, safe deliveries among pregnant women.”

“The project is aligned with the GoSL’s National Development Plan 2019–2023, whose main objective is to accelerate human capital and transform the health sector into a well-resourced and functioning national health care delivery system that is affordable and accessible to all,”  Kofi Amponsah, World Bank Senior Health Economist and Task Team Leader, announced. “The project will collaborate with sectors beyond health which have impact on health and nutrition outcomes, such as in water, agriculture, education, and energy for greater cross‐sectoral links and synergies”.

Last Friday, 1st April 2022, President Bio formally acknowledged this funding and thanked the World Bank at an event held in State House Freetown, where he spoke about the importance of the  Quality Essential Health Services and Support Project.

This is what he said:  

“Honourable Ministers of Government, Representatives of the World Bank, Executive Director, Partners in Health, Distinguished Ladies and Gentlemen, Good morning: I want to start by thanking The World Bank for sharing and supporting our vision that strengthening health systems and improving health service delivery is critical for human capital development and for sustainable development.

We made a simple argument in our manifesto that “development is about people” and “no meaningful development can take place in any nation without developing the human capital.” Part of involves “improving health care, [and] protecting poor and vulnerable population groups.” We were mindful of health disparities and moved by the poor state of health services in 2018.

We have followed our commitment to achieving Universal Health Coverage with concrete actions including increasing the healthcare budget, recruiting and training more healthcare staff, restructuring our health sector, improving and expanding national ambulance and laboratory services, expanding the range of healthcare services, refurbishing and building healthcare facilities, and improving access to and affordability of healthcare across the country. Some weeks ago, at York Village, we introduced a health-on-wheels initiative to take healthcare into under-served and far to reach communities.

By taking healthcare services to within a five-mile radius of every Sierra Leonean, we have improved health outcomes and lowered disease burdens. Maternal and infant mortality are down and we will work to reduce them even further. Vaccination rates are higher now. Malaria kills far fewer Sierra Leoneans now. More persons living with HIV and TB are receiving life-saving medication.

We have strengthened disease surveillance teams and we have quickly and effectively responded to potential epidemics. We have successfully fought against successive waves of COVID-19, (to much international acclaim, I must add), keeping fatalities to a minimum.

In all of this, we have been intentional, inclusive, and innovative, knowing that each Sierra Leonean deserves to live a healthy life and contribute his or her fair share to our nation’s development.

So, I want to thank our development partners who have believed in us and believed with us that our goals are achievable. You have generously supported our shared aspirations for our people with technical expertise, equipment, and grants. Thank you.

Previous speakers have laid out the scope of the project from various perspectives. This project concretises our ongoing development partnership with the World Bank. It also enhances our partnerships with Partners in Health (PIH-SL. We are engaging them to replicate the Kono model in Kailahun, as well as support the other four districts to achieve same impressive outcomes.

As I have indicated, we are intentional about our interventions. We have looked at the data and looked at the comparative poverty rates. We have selected areas with high poverty rates: Bonthe, Falaba, Kailahun, Tonkolili, and Western Area Rural. For those who speak in terms of regional distribution, that’s two districts in the north, one in the south, one in the east, and one in the west.

Additionally, we considered that these areas shared one or more of the following: high disease burden, high number of deliveries, geographically hard-to-reach areas, large numbers of patients, large catchment populations, high population with high healthcare service utilisation.

In addition to the foregoing, Falaba was declared a district by the previous government without a district hospital or district health management team office. Since 2018, we have had to develop new health systems for that district and we are working hard on that. We will soon pronounce the result of our efforts for the good people of Falaba.

As indicated, the project is intended to address high levels of maternal and child mortality in Sierra Leone in the beneficiary districts. So, the primary beneficiaries are women and children. This grant will be used to finance a hub-and-spoke services delivery model. We will identify hubs in each district cluster and then distribute and improve quality essential health services at each of the satellite stations.

The following district facilities will be upgraded as hubs: For Bonthe District: (United Brethren in Christ (UBC) Hospital, CHC Moriba Town, CHC Tihun). For Kailahun District: (CHC Bandajuma Yawei, CHC Buedu, Jojoima-CHC). For Falaba District: (CHC Kurubonla, CHC Falaba, CHC HEALTH SYSTEMS STRENGTHENING 5 5 Mongo). For Tonkolili District: (CHC Hinistas, CHC Masingbi, CHC Bendugu). For the Western Area Rural (Waterloo, CHC Goderich)

We intend to achieve a number of goals with this project. First, we want to ensure that skilled health personnel are available in target districts. Secondly, pregnant women should attend ante-natal clinic at least four times and all deliveries are attended by skilled health personnel.

Next, we want to ensure that children are fully immunised. Finally, all mothers and children should receive basic nutrition services in health facilities.  Therefore, we intend to invest this grant in a number of core areas in order to realise our project outcomes: For staff training, we will strengthen academic staffing, review curriculum, and establish a formal affiliation between the University of Sierra Leone and the Makeni School of Clinical Sciences.

Further, there will also be support for curriculum development for Medicine and Allied Health Sciences, including the Dentistry Department and Public Health Department and Midwifery School.

The grant will also help the Government of Sierra Leone finance and expand ongoing training of general surgery students, including ensuring full accreditation for postgraduate training in paediatrics, obstetrics, and gynaecology.

The project will also support specialised postgraduate training in medico-surgical nursing, midwifery, and paediatrics and other relevant fields. We will also enhance our recruitment and training initiatives.

At the community level, first aid kits will be supplied to selected schools in Bonthe, Falaba, Kailahun, Tonkolili, and Western Area Rural Districts. Teachers will be trained in basic health care skills to allow them to treat first aid cases that occur in schools.

For infrastructure, we will construct the 14 health facilities designated as hubs and spokes. We will also ensure the provision of laboratories, and medical equipment and supplies. We will also apportion some amount to supporting operations of the national ambulance services.

The project will also pilot an eco-friendly Centralized Bio-Medical Waste Treatment Facility in Western Urban and Western Area Rural districts in the Freetown area. At the operational levels, we will install facility-level management information systems that will enhance the development of integrated clinical processes, data registries, digital forms, and other documentation. As a consequence, digital patient files will be generated to inform clinical decision-making as essential parts of the electronic medical records system.

Critical to attaining universal health coverage is sustainable healthcare financing. The project will support the Sierra Leone Social Health Insurance scheme that will drive the objective of making healthcare affordable.

The grant will also support the local production of affordable, nutrient- and protein-rich foods, including Bennimix. This enhanced protein-rich food will support the growth of malnourished infants, children under 5, pregnant and lactating mothers, and other vulnerable adults.

Distinguished Ladies and Gentlemen, let me close this short statement by thanking the World Bank again for their generous support. We also anticipate working effectively with Partners in Health over the next five years as we implement this project.

As I have always said, human capital development will drive and accelerate sustainable development in this nation. We will pursue that objective with purpose.

I thank you for your kind attention and I now formally pronounce receipt of a grant of Sixty Million United States from the World Bank to the Quality Essential Health Services and Systems Support Project.”

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