Sierra Leone

Saving Lives in Sierra Leone (SLiSL) Phase II: Value for Money (VfM) / Cost-Efficiency Report (May 2021)

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Executive summary:

This Value for Money report presents the second ex-post cost-efficiency analysis results of the Saving Lives in Sierra Leone (SLiSL) programme for the period of January–December 2020. The SLiSL programme is supporting the Government of Sierra Leone to save women’s and children’s lives by improving the quality, availability and accessibility of reproductive, maternal, new-born, child and adolescent health (RMNCAH) services.

  • Efficiency of EmONC Mentorship in 2020 (£6,186/mentee) was maintained compared to 2019 (£6,207/mentee). Efficiency was slightly higher in urban areas that required less travel distance compared to rural areas. Given that reducing the number of mentors to cut costs may have the unintended effect of decreasing overall efficiency, the remaining mentors will need to cover more mentees and target the most critical areas for improvement during each visit.

  • Efficiency of ETAT Mentorship in 2020 (£578/mentee) was lower than in 2019 (£431/mentee), due to a decrease in the number of health workers mentored and an increase in costs of short courses, ETAT+ manual revision and printing, and transportation caused by the pandemic.

  • Efficiency of Adolescent Outreach Sessions in 2020 (£1.82/attendee) was mostly maintained compared to 2019 (£1.22/attendee). In addition to the highly effective Community Based Mobilisers, efficiency was maintained by planning outreach sessions according to school schedules, leveraging community network meetings, and empowering school health clubs with practical information on where and how to seek services.

  • Efficiency of Community Network Meetings in 2020 (£4.77/attendee) was lower compared to 2019 (£0.93/attendee), because more priority was given to adolescent outreach therefore less community network attendees were reached.

  • Efficiency of Family Planning Services Provided Through Outreach in 2020 (£4.93/CYP) was higher compared to 2019 (£9.63/CYP). COVID-19 contingency plans were established to ensure that services continue to be available. The outreach teams flexibly pivoted to work in chiefdoms with lower COVID-19 incidence and strategically planned their visits to remote locations according to the season.

  • Efficiency of Family Planning Services Provided Through Public Sector Strengthening (PSS) in 2020 (£10.56/CYP) was lower than 2019 (£8/CYP), because the number of CYPs generated decreased but was still better than COVID-19 scenario projections. Efficiency was maintained by conducting quarterly “inreach” to health facilities and motivating service providers with non-monetary incentives.

  • Efficiency of Drug Distribution in 2020 (£0.01/unit of drug distributed) was equivalent to 2019 (£0.01/unit of drug distributed). To improve efficiency, first mile transporters can be outsourced to contractors, while last mile transporters will be insourced by utilising existing delivery vehicles and GoSL drivers.