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Strengthening health service delivery in rural communities

Strengthening health service delivery in rural communities

Twenty-eight year-old Nancy Amara arrived at the newly constructed Community Health Post (CHP) in Dodo Kortuma, Luawa Chiefdom, Kailahun District by 7am in great pain. Exactly one hour thirty minutes later she delivered her third girl child with relative ease.  (Photo: NANCY: first patient at the newly constructed CHP at Dodo Kortuma, Kailahun District)

A couple of hours later on Saturday, 23rd June 2018, the CHP was officially commissioned and Nancy Amara would be recorded as not only the first patient to be treated at the new health center, but also the first woman to give birth there.

I met her at the maternity ward, seated on the edge of the bed and watching over her little sleeping angel purposely wrapped in blue cloth. Her other child, 3, stood beside her.

“I feel happy and relieved,” she said, smiling. “I was worried they would not admit me since the health center was not yet officially opened by the authorities. I thank God, however, I delivered safely.”

Built in 1964 the original health center, which was in a crumbling state, was demolished to give place to the new CHP, the construction of which started in 2017. Constructed by SEND Sierra Leone with funds from the Zochonis Charitable Trust Fund through Christian Aid, the Dodo Kortuma health post lies about 14 rugged miles from Kailahun town. It is expected to provide health services to seven surrounding communities with a total catchment population of 5,716, about 1000 of who are Under-5s.

Accessing the health post is mostly by foot for the majority of the population. Those who can afford do so by commercial motorbikes (Okadas) and the cost varies depending on how close or far away one resides. But from Kailahun town to Dodo Kortuma the motorbike fare is about US$10 (Seventy to eighty thousand Leones) for both ways.

Having a health post is one thing, accessing it is entirely another; noted Augustine Fayia Jusu- the Community Health Assistant (CHA) attached to the facility.

Yet Augustine is equally happy the center was completed during his time as the CHA.

“I am delighted that the CHP was commissioned during my tenure. I supported the building contractors and the implementing organisation and together we have done it,” said Augustine.

Augustine took me on a conducted tour of the health facility, showing me the good and the bad. The Dodo Kortuma CHP has about 17 rooms and 10 functional beds, the largest I have seen in all the chiefdoms I have visited in Kailahun District. There is a Delivery ward, Antenatal Care ward, Outpatient ward and a reception area. Outside the building there is an incinerator and a toilet.

However, Augustine was concerned about challenges with access to water and electricity.

“For electricity, we can understand that it’s a national problem but there’s no way a health clinic can run efficiently without water,” said Augustine.

The water well at the front compound of the health post is non-functional, so the community depends on nearby streams for water. At this season of the year it is not feasible to dig water wells.

There is also no placenta pit at the moment, but Augustine said they are engaging the community to help with location and man power.

Other challenges include lack of furniture and shelves to keep drugs; refrigerator to preserve vaccines; and staff accommodation and mobility.

According to Augustine, the CHP is entitled to quarterly supply of drugs from the District medical stores but sometimes go beyond four months without supplies.

Sierra Leone reportedly has the highest maternal mortality ratio (MMR) in the world, with 1,360 maternal deaths per 100,000 live births. One in every 17 women bear the risk of dying during labour, according to the United Nations Fund for Population Activities.

SEND Sierra Leone Program Officer for Kailahun District, Steven Sahr Bundor, speaking during the commissioning of the CHP, urged the community people, especially women, to make good use of the facility.

“The health center is for you; so visit it even when you are not sick; especially you pregnant women, breastfeeding mothers and your children under five years old,” said Steven.

Apart from also urging the health staff to equally take good care of the facility, Steven further called on the DHMT to fulfil their own part by ensuring the provision of necessary equipment, drugs and furniture for the CHP. He admonished the Facility Management Committee (FMC) to take ownership of the health post together with the Village Development Committee (VDC) to see that the CHP is run properly to provide efficient health services to the communities and the Ward Development Committee (WDC) together with the District Health Management Team (DHMT) to ensure the sustainability of the structure.

The Chairman of the Kailahun District Council and his deputy officially unveiled the Dodo Kortuma Community Health Post following a short traditional ceremony of statements and celebration involving the members of the community and its surroundings.

The SABI project seeks to improve on the efficient delivery of basic health services in the district to ensure citizens have access to quality health services which will lead to reduction in maternal and infant mortality.

Meanwhile, Nancy said she will be an example to her colleague women and she will encourage them to visit the CHP regularly.

By Ahmed Sahid Nasralla (De Monk)

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