Health and safety first for women and children in Sierra Leone
Sierra Leone is not a safe place for a woman to be pregnant and a child to be born. One in twelve children still die before their first birthday, and the lifetime risk for women of dying from complications of pregnancy and childbirth is one in eight. Utilisation of health facilities is also very low. Typically in West Africa a newborn child would need to visit a health facility three times - in Sierra Leone this happens only 0.5 times, largely due to poverty. As a survey in 2008 showed, 88% of respondents cited lack of finance as the reason for not seeking care from health services.
In a country where 70% of the population lives in poverty, formal and informal charges constitute the biggest barrier to accessing health services. But from 27 April 2010 (Independence Day) this is set to change, as the Free Health Care Policy is launched.
Under the policy, user fees and charges will be abolished for health services delivered at government facilities to pregnant women, lactating mothers and under-five children. In its first year only, it will potentially benefit 237,000 pregnant women and 1,000,000 infants.
Since the announcement of the Free Health Care initiative in November 2009 the country and its partners have been gearing up to meet this ambitious deadline.
DFID has provided £5.5m for the procurement of drugs and supplies - which have arrived in time for the launch - and has significantly strengthened its staffing capacity to support the design and implementation of the initiative.
But providing 'free' health care has costs. Currently fees and charges represent a substantial supplement to health workers' salaries, which alone do not offer a competitive or living wage. As a health worker remarked 'how could the government expect me to feed and educate my children on my current salary?'
To address this issue, and the risk that health workers move to private practice or abroad, the Ministry of Health is proposing to increase health workers salaries. DFID is providing crucial technical assistance to computerise and clean up the entire payroll -a necessary prerequisite to remove ghost workers and ensure that all qualified healthcare workers delivering services are paid. Additional technical assistance to strengthen the Ministry's financial management and procurement systems, human resource planning, drugs supply management and monitoring and evaluation, will also arrive at the beginning of April and build the capacity of the Ministry over the next three years.
The Centre for Progressive Health Financing, announced by Secretary of State on 11 March, will be able to provide the necessary technical support to countries like Sierra Leone that are committed to increasing accessing to quality health services by poor people.
DFID has worked closely with the Ministry of Health and Sanitation and partners to put in place a comprehensive response to the challenges in the Health Sector providing £16 million to support its delivery to 2012. Specifically:
* A national reproductive and child health strategy was launched by the President and a costed operational plan has been developed;
* A national basic package of essential healthcare services for the entire health sector has been designed and endorsed by all partners;
* And a framework to deliver free quality healthcare services for all pregnant women and young children has been finalised.
On 5 November 2009 the President launched Sierra Leone's first 6-year National Health Sector Strategic Plan. This is a culmination of all the work that the Ministry and partners including DFID have undertaken and provides a solid plan for how the people of Sierra Leone, especially the most vulnerable, can have access to quality, equitable, essential healthcare services.