It’s a new year at the Children’s Hospital and everyone is cheerful.  The figures from the last months of 2009 suggest that inpatient mortality has decreased substantially, compared to the equivalent period in 2008.  We are also more popular; the number of inpatient admissions has tripled over the past six months.

The Children’s Hospital is fortunate to have substantial support from Cap Anamur (German Emergency Doctors), who pay attendance-based monthly incentives to staff and provide free drugs and consumables to all inpatients.  But this is not a long-term project and may end as early as July this year.  The Welbodi Partnership, which I volunteer for, does not yet have the resources to step in and take over this expensive project, though we are doing our best to seek other options.

The staff rightly dread going back to the dark days of previous years, when children died for lack of drugs that their parents couldn’t afford and staff attendance was much less.  As I have said in a previous blog, the junior nurses are paid only 120,000 LE (around 30 USD) monthly by the Government, meaning that, prior to the incentives scheme, many of them had other jobs to make ends meet.

In fact, there are big changes afoot in the whole health care system in 2010.  With considerable encouragement from donors and NGOs, the President has announced that health care will be provided free for all pregnant women and children under 5 years old from 27th April 2010, the country’s Independence Day.

We do not yet know how this will work on the ground.  Can we hope for an increase in healthcare workers’ Government salaries?  Can we expect a regular supply of drugs and essential consumables (e.g. gloves, cannulas etc) to the Hospital?

One thing that seems fairly certain is that the Government intends to eradicate the informal user fees charged in all healthcare facilities.

There’s no doubt that user fees are a barrier to healthcare and everyone agrees that they need to go.  The challenge is how to deliver quality healthcare for free in a system that currently relies on those user fees.

At present, a consultation fee (15,000 LE; 3.8 USD) supplements the Hospital running costs and doctors’ wages.  The Hospital management faces a long and difficult procedure to get funds or resources from the Ministry and has not had any drug supplies from the Ministry since 2006.

The Government, donors and NGOs are meeting regularly in the coming weeks to devise a plan that we hope will make the President’s promise come true on 27th April 2010.  I will keep you updated!

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.