Sierra Leone’s Free Health Care System Overwhelmed

By Mohamed Juma Jalloh
Many so called great nations around the world are struggling to get their health systems efficient and effective for their citizens, and poor Sierra Leone is not an exception.
Whiles the United States vacillates between Obama Health Care and private Health Insurance, England deserves credit for the establishment of a National Health Service (NHS) which is a health care scheme for all her citizens.
Brexit was in part motivated by a desire to jealously protect social services from being overwhelmed by uncontrolled and unregulated influx of foreign migrants.
However, British meanness at home is quite dissimilar to the immeasurable support she has rendered to the health sector of one of her former colonies in West Africa- Sierra Leone.
The introduction of Government’s Free Health Care (FHC) in 2010 for pregnant women, lactating mothers and children under five years supported by DFID, has kept the scheme alive through its Department for International Development (DFID) Programme.
DFID has contributed considerable funds through the provision of essential drugs and commodities, training of health workers, support to improve access to family planning and the construction and rehabilitation of health facilities across the country.
To further demonstrate her commitment to improving access to quality health care for FHC scheme, the UK government in 2016 committed 150 million pounds for the health sector until 2021 under the Saving Lives programme.
“The programme aims to save the lives of 2000 pregnant women and lactating mothers, and 20,000 children in the country,” DFID Deputy Head of Country Office disclosed.
The Government of President Bio as a way of demonstrating local ownership of the Free Health Care scheme has re-affirmed its commitment to provide 50% of funds to manage the scheme by 2020.
At present the government is only contributing a 10% paltry for the procurement of FHC drugs, the rest of the lion`s share is contributed by DFID.
The scope of the FHC scheme has been widened by the Government of Sierra Leone to accommodate other vulnerable groups such as amputees as a consequence of the civil war and survivors of the Ebola scourge.
Government is also intending by 2020 to extend the scheme to all government and government-assisted schools to support the Free Quality Education flag ship project.
This, according to the Minister of Health and Sanitation, Professor Wurie, would bring the percentage of Sierra Leoneans accessing free medical service to 50% from the present 30%.
Despite the collaborative efforts of government and development partners, Sierra Leone`s maternal indices remain appalling.
The WHO says the country has the highest maternal mortality ratio in the world (MMR) with 1,400 maternal deaths per 100,000 live births.
When further disaggregated it means one in every 18 women bear the risk of dying during labour.
The Princess Christian Maternity Hospital (PCMH) which also houses the Ola During Children’s Hospital, the only Pediatric Hospital for Under Five Children in the country, is the national referral center that solely renders Pediatrics and Gynecology services for women and children.
This Children’s Hospital is hugely supported by foreign doctors from the sub region and the UK.
It is mostly overwhelmed and largely not able to effectively deal with the number of cases that are reported at the hospital on a daily basis.
The center records the highest visitations as women flock in droves to access the facility.
According to Dr. A.V Koroma, the Doctor in-Charge, the national referral center receives over 2000 patients on a monthly basis.
Public demand for the FHC continues to rise without corresponding increase in the hospital`s capacity to accommodate more patients.
It is expected that the building of additional four hospitals by DFID in Lumley, Kingharman Road, Rokupa and Waterloo would lead to an increasing response to maternal and child health issues in the country.
One of the 30 foreign specialists in the country to aid in FHC prefers to be anonymous.
The Caucasian pediatrician revealed that the hospital is constrained with erratic water supply which automatically renders the hygiene and sanitation environment unconducive for children receiving their first breath on earth in the hospital.
There are only four properly trained gynecologists and obstetricians in the country to improve the human resource strength and at the same time provide training for the local health work force in neo and antenatal maternity care.
The number of the local workforce has been increased up to 4,000 but at the same time many nurses have abandoned their health posts due to lack of pin codes to access government salary and other benefits.
After losing 300 nurses and 12 doctors to the Ebola scourge, volunteer nurses must be incorporated into the main stream health structures in order to bridge the gap between rural and urban health care delivery.
Public health education must be accelerated so as to increase accessibility to the FHC services.
Many pregnant women meet their demise during labour as Traditional Birth Attendants (TBAs) lack the skills and training to handle birth complications.
Patients come very late after they have been mismanaged by TBAs.
In the process when the situation becomes uncontrollable, they are hurriedly brought to Peripheral Health Units (PHU).
PHUs are also grossly incapacitated to handle birth complications such as hemorrhage, hypersensitive disorders, sepsis and abortion, birth asphyxia, intrapertum related neonatal infections, and complications of preterm births and deaths.
All these conditions accounts for 85percent of maternal and new born mortality.
In order to step up the fight in the reduction of preventable deaths of women and children under five years, the country has developed a new 5-year strategy 2017 -2021 which aims at drastically reducing the scourge.
The new direction government must roll out action oriented programmes such as nutritional support to beneficiaries of the FHC because a malnourished pregnant woman would deliver a malnourished baby there by endangering the chances of survival for both the mother and the new born baby.
The corrupt attitude of some health workers has unfavorably hampered the success of the FHC.
Nurses in health centres normally demand money for soap and plastics from relatives of pregnant women during delivery.
A patient that is accompanied by a well to do relative commands proper care and attention from the nurses.
Basic drugs such as paracetamol and artesunate are administered to the beneficiaries but essential and expensive drugs such as syrups and injections are hoarded by hospital staff, store keepers, security and later resold to the beneficiaries of the health scheme.
Essential drugs are often sold to private pharmacies across the country because there is no software to track the distribution of drugs country wide.
Some of the drugs supplied to the health centers are close to their expiry dates.
Many PHUs lack a coal chain to keep the medicines and vaccines in an appropriate temperature.
Despite the massive distribution of bed nets, Malaria continues to take a severe toll on children under five years, the disease which is deadly is transmitted by the female Anopheles mosquito.
Measles, malnutrition and cholera are also among the biggest killers of children in Sierra Leone.
The ambulance system is fairly working but unregulated structures and inaccessible roads have limited its reach to slums and hill side communities.
If the FHC is to make positive impacts government must match financial commitment with political will.
The provision of essential drugs must be monitored by digital software to track delivery from medical stores to PHUs.
Government must upgrade the skills of midwives and nurses to handle birth complications.
It is also rational to appreciate and understand that the social determinant of health falls to many traditional partners such as the Ministry of Water Resources, Energy and Power and proper housing.
Given the many factors that influence health it should be considered a shared responsibility with other sectors including the private sector.

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