Sierra Leone’s free healthcare programme – the untold stories

John Baimba Sesay: Sierra Leone Telegraph: 4 November 2018:

When the government of former President Ernest Bai Koroma launched the Free Health Care Initiative (FHCI), in April, 2010, it was with the desire to enable pregnant women, lactating mothers and children under five access free medical care and services. This remains part of his success stories, as it is with infrastructure – especially the road network across the country.

The Initiative was in fact, according to UNICEF, “a grand sum of Sierra Leone’s efforts, as it addressed all dimensions related to reproductive health from quality service delivery to ensuring access and utilization through demand generation.” (Read:  Free Health Care Initiative: UNFPA Support in Sierra Leone).

Its introduction, as would be expected, saw an increase in the number of people accessing health care units across the country and further resulted in reduction of both maternal and infant mortality. We saw greater improvement in the World Health Index by 2015.

Eight years on, the initiative is today faced with huge and disturbing challenges, and the need for urgent government attention cannot be overemphasized.

Sophie Witter is a Professor of International Health Systems at Queen Margaret University, Edinburgh, UK. Reviewing the initiative after six years of its launch in 2010, she said, much as the focus was on making mother and child health services free, the Government and its partners realised that in a weak, post-conflict health system, this could only be done if all of the main health system elements  – “availability of staff, structures for managing the sector, monitoring and evaluation, drugs and supplies, health facilities, and communication were improved.”

Visiting cottage hospital has given me a better view of happenings there. These are the untold story:

We had rushed our baby to the PCMH Cottage Hospital in Freetown, following a private doctor’s referral. Mum and daughter had to stay for five days at the hospital – bitter-sweet experience.

Returning home with a healthy baby brought happiness, but punctuated with the bitter memories of the challenges the hospital is facing, from infrastructure to the need for more personnel and above all, the need for better professional care by some of the health professionals, such as nurses.

On a positive side, it was good that the Free Health Care Initiate for pregnant women, lactating mothers and children under five was introduced. Today it saves lives, as those who cannot afford visiting private medical care are provided with an alternative.

“Why did you go to cottage?” a friend had asked. Well not just because it was a private doctor’s referral, but because lives are saved there too, added to the fact that there are committed professionals there, though with room for improvement.

This notwithstanding the mind-blowing challenges, especially the need for more infrastructure (accommodation and beds), more personnel and improved professional care by our serving nurses, hygiene (preventing cockroaches and bedbugs from cohabiting with patients).

It is unacceptable, that a bed should accommodate two patients (babies) for as long as the patients stay in the hospital; call it four people per bed – two babies plus their parents. This is the case at the emergency referral ward at Cottage.

The Ministry of Health and Sanitation should look into this situation urgently. Health they say, is wealth and just like the decision to invest in developing the country’s human resource through the free quality education, we must also be looking at how the free healthcare is being delivered to ensure better outcomes and quality.

The free health care programme must be sustained for the good of country and its people.

Professionalism is another issue. Granted, we have an encouraging number of nurses doing extremely well in terms of service delivery.  We witnessed a situation where a matron was on duty from the early hours of the morning until about 9 pm at night, serving diligently, with utmost patience and care. She was, in my opinion, more than a nurse – a mother she is.

Having said that, it is disturbing that some staff get to work late, others treat parents with derision, adding to their psychological trauma of seeing their sons/daughters sick and some literally giving up the ghost.

Communication is another challenge, and as Sophie Witter argued, it is one of those elements that should work well if the free healthcare programme is to become a huge success.

Here is an example; a nurse had taken another child to the emergency ward from the resuscitation (resus) centre, without first calling her colleagues to find out if there was an empty bed. The child, according to findings, was on Oxygen. The rest, one would say, is history.

The hospital has a problem with personnel; few nurses; many are working as volunteers and would not come to work for many days. When one nurse is left to serve dozens of children, it becomes a burden on her alone.

Volunteering staff should be absorbed into the system on a full-time basis, so as to enhance service delivery. Salaries for nurses should also be increased.

I was at the hospital one day when, in less than two hours, three children died. Death, factually, is one inevitable commodity. But when it happens in such rapidity, one is bound to panic, and I was frightened.

Luckily, my daughter was to leave the very day, after 8 pm, and I was grateful that God, through those dedicated doctors and nurses on duty, got my daughter up and running and home she came.

But then, as we drove home, I reflected on those families left behind, with their children, sleeping two to a bed, and the other numerous challenges faced by the hospital staff.

It is time for those untold stories to be heard and challenges fixed.

1 Comment

  1. I am not sure there is a shortfall in the numbers of nurses to man the current health facilities. I know of a government health facility where the nurses talk, shout and laugh among themselves more than 8 hours a day, only doing minimal work. The facility attracts few patients as there is never any visible sign of a contention for its services.

    It is obvious that the facility is over-staffed. Employing more health workers is not going to solve any problem. They will always complain that they are not being paid well. Basically these nurses and health workers steal the FHC drugs and run pharmacies from their homes. Some of them even provide medical services just like doctors. The ACC should look at these people seriously.

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