Emily Spry: The free health care initiative in Sierra Leone

Pikin HospitalIt is now less than one week until the launch of the free health care initiative in Sierra Leone when, as regular readers will know, government health facilities, such as my own dear Children’s Hospital, will be required to provide free healthcare to children under five, pregnant and breast-feeding women.

The big day is Tuesday 27th April, Independence Day, when the nation will celebrate 49 years since the end of colonial rule by Britain.

Clearly, this is a hugely complex project and myriad things need to come together to make it possible.  A good deal of money is being spent by the UK Department for International Development (DFID), UNICEF, and several international non-governmental organisations.

One key step has been to increase health-worker salaries to a living wage, so that it is plausible to demand that they stop charging user fees.  This has been done, though negotiations did involve a full-blown strike.

My sources now tell me that the strike was only ended by a secret meeting in which the President agreed to increase salaries further. This apparently will ensure that first year doctors take home $600 after tax, rather than being taxed heavily on a gross salary of that amount.

Of course, the salaries haven’t actually been paid yet and many beleaguered health workers prefer to reserve judgement “until we feel the money in our pockets”.

The second key issue is for the government to supply free drugs and consumables to the hospitals and clinics for the first time in many years.

I’m sure that UNICEF and the others had a strategy for this at some level.  Certainly, they have brought several million dollars’ worth of drugs into the country.

For many months now, I have tried to find out which drugs we can expect at the Children’s Hospital, and how much thereof.

Just three days ago, the Hospital Pharmacist finally got a list.

Unfortunately (and AGONISINGLY predictably), whoever wrote the list clearly has no idea what the Ola During Children’s Hospital is (the clue is in the name) and what that might mean in terms of our drug needs.

According to this list, we are to be given the same drugs at the same quantity as if we were a small primary health unit.

Thus, we have been allocated inappropriate drugs and consumables (clotrimazole vaginal suppositories, anyone? Or would you like to have our allocation of drugs used only in childbirth?)

I can’t see any injectible anti-malarials on there, though I’m still hoping that I’m missing something.

And we have been allocated tiny quantities.  In a really staggering disappointment, we have been allocated 13 intravenous cannulas.  For a hospital that admits around 800 patients a month.

We are trying to engage the relevant people to make changes but, with three working days to go before the launch (and nothing yet delivered to the Hospital), it may well be too late.

Another key to all this is communication.  A truck turned up at the Children’s Hospital today, pumping out music and blaring messages about free care.

Who is going to tell an expectant public that it’s only basic healthcare that is free? (if your child needs a second-line antibiotic, you will need to go out and buy it or go without).  Who is going to tell them that the 13 cannulas have run out?

I found out today that the President is going to launch free health care at the Children’s Hospital.  I’m not sure if that will be a blessing or a curse.

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.

  • Henning Ringholz

    The criticism concerning inadequate quantities of drugs delivered to the hospital is valid. However, in the interest of a balanced view on the issue several aspects should be noted:
    Firstly, the introduction of Free Healthcare for pregnant women, lactating mothers and children under 5 is a major achievement for a developing country such as Sierra Leone. When criticizing some aspects of its implementation, the impact this initiative will have on the lives of Sierra Leoneans, and the hard work by the government, donors and partners should not be underestimated.
    Secondly, with the help of the Sierra Leone government, donors and partners, more than US$ 10 million worth of drugs have been distributed to the 1200 Primary Healthcare Units and other health facilities in the country. Completing such a task in a country that still suffers under poor infrastructure is highly commendable. The people and government of Sierra Leone owe gratitude to donors and partners that have supported this achievement, particularly UNICEF, which was responsible for the distribution of the drugs.
    Thirdly, some of the challenges mentioned in the blog reflect not weaknesses in the policy or approach, but they are proof of the hard work and determination by the government to make Free Healthcare work. As an example, the debate over doctor’s salaries was an important challenge that had to be overcome in order to make Free Healthcare a reality. However, rather than focusing on the fact that it took a strike to resolve the conflict, the positive outcome should be stressed. As a result of the negotiations, which contrary to the author’s view were not “secret”, but orderly and carried out under intense public scrutiny, salaries of all doctors were increased substantially. This significant effort by the government, supported by donors and partners, will allow health staff a significantly better standard of life, and contribute to better morale and retention rates.
    Free Healthcare has only started, and without a doubt many challenges will still have to be overcome, including the small supply of drugs for Ola During hospital.
    However, in order to make this initiative a success, a positive outlook and trust in the ability of all stakeholders to give their best and contribute to the project will be key.

  • Emily Spry

    Thank you for your comments, Henning.

    I realise that this piece wasn’t balanced and I apologise for that. I hope that my subsequent blog made this clear.

    I am 100% behind the concept of Free Health Care and have nothing but respect for the President, the Ministry of Health and Sanitation, its donors and partners who have worked so hard to make such an important and complex initiative happen.

    When writing this blog, I was very frustrated by the drug allocation process and failure to supply appropriate drugs to the Children’s Hospital, essential if we were to fulfill the expectations of the patients.

    At the end of a hectic and exciting week in which the Children’s Hospital saw 6 or 7 times their usual number of patients, there is no doubt that Free Health Care is in huge demand and is really taking off.

    The launch of the Free Healthcare Initiative was only the beginning. There is a lot more work to do and I feel very privileged to be here as Sierra Leone takes these bold steps.