Sierra Leone’s Health Care System needs a robust overhauling: Bridge to a Better Life is keen on providing health support to rural communities
Sierra Leone is situated on the coast of West Africa with a population of 7.4 million, of which at least 1 million live in the urban environs of the capital Freetown. Its development has been hampered by a civil war between 1991 and 2002 and more recently by the Ebola outbreak of 2014, which claimed nearly 4000 lives, of whom over 90 were qualified health care workers (approximately 7% of the workforce).
The health system in Sierra Leone is routinely characterized as a space of failure. This became especially evident during the Ebola outbreak, when the tragic inability of public health facilities and hospitals to diagnose, isolate or care for patients or to protect health workers was widely reported in global media, often via tragic images and sensationalizing descriptions of suffering Sierra Leone’s health system is also known for its high infant and maternal mortality rates. In 2010, the government established the Free Health Care Initiative (FHCI) to curb these mortality rates by abolishing all charges at government health facilities for pregnant and lactating mothers and children under five years of age. The FHCI included several reforms, including raising the salaries of health workers to decrease the likelihood of them charging user fees to augment their meagre income Whilst FHCI received much (inter)national praise during its early years, it was also heavily donor-dependent, with 87 % of its costs funded by external partners and its sustained success has been hamstrung by increasing demands, low staffing, and stock-outs of drugs and diagnostic supplies, resulting in high out-of-pocket costs for patients.
The burden of disease is predominantly communicable disease, with 25% of deaths due to malaria, 9% due to hypertension and 9% due to maternal causes.In outpatients, the predominant conditions are tuberculosis, human immunodeficiency virus, hepatitis, hypertension and diabetes.Ebola exacerbated an already challenging situation in terms of human resources. There are 1.4 doctors, nurses and midwives per 10 000 population compared to the most recent sustainable development goals threshold (set in 2016) of 44.5.In absolute terms, this equates to a qualified workforce of just over 1000 doctors, nurses and midwives, with an approximate shortage of 32 000. There is only one medical school in the country from which approximately 30 graduates pass out per year.
Within Sierra Leone, there is also an urban–rural split,with many doctors preferring to live and work in the urban areas. The Sierra Leone health care system is organized into two tiers of care: Peripheral Healthcare Units (PHUs) with an extended community health program and secondary care which includes 21 district and three referral hospitals; there are also 45 private clinics and 27 private hospitals, mostly in the Freetown area.
The PHUs are further subdivided into maternal and child health posts serving a population of 500–5000, Community Health Posts serving a population of 5000–10 000 staffed by State-Enrolled Community Health Nurses (SECHNs) and Community Health Centers (CHCs) at chiefdom level serving a population of 10 000–30 000. Community Health Centres are run by Community Health Officers (CHOs) supported by SECHNs, lab assistants and environmental health workers.
With such a challenging combination of circumstances, it is not surprising that Bridge to a Better Life is keen on providing support to rural communities to establish more health facilities and clinics at rural communities in Sierra Leone to ameliorate the health challenges encountered by deprived women and children and eventually bolster the health gains that have been made in the health sector.