A healthy Sierra Leone is a wealthy Sierra Leone
I was amazed when I read an article in the ‘Awoko’ newspaper dated November 30, 2011, entitled ‘Government to Introduce Health Insurance Policy’. This was a statement made by the Dr. Kelfala Marah, Chief of Staff (COS) in the Office of the President. Sierra Leoneans should be pleased that a senior government official has informed them of this forthcoming policy. The proposal is a true insinuation of government; that is, ‘government for the people’.
The term policy is used broadly to refer to expressions of general purpose, decisions, practices, statements, purposive course of actions, regulations and laws. When it specifies Health Insurance Policy (HIP), there are indicates that decisions will be made by consensus about health services and the delivery of these services to the populace. This implies that the HIP will involve decisions by politicians, medical authorities and administrators. These decisions will be put forward as a statement of intent or strategies, which will in turn have an impact on the provision of healthcare services and health infrastructures. The HIP may extend beyond healthcare services to include environmental and socio-economic effects on health.
As our nation moves through the recovery stages of the civil war, the delivery of an appropriate quality healthcare should be a priority for the government. Indeed this HIP will be a backup to the Free Health Care Policy that is already functioning well. When enacted, the HIP will deliver on a continued basis services to meet the challenges of ongoing disease conditions, such as, chronic non-communicable diseases, malaria, AIDS and others. These challenges will be compounded by the daunting task of effectively financing the healthcare in an environment of ever increasing expectations and poverty.
The Budget Advocacy Network’s (BAN) concern for the reduction of health allocation in the 2012 National Budget is well noted. However, I believe this reduction could regenerate into finances that may cause less burden on the coffers of government when, in sincerity, the HIP is implemented. Indeed, I believe Sierra Leone will achieve the Millennium Development Goal by 2015 in the health sector when the HIP comes into place.
The critical challenge is to move from policy to implementation, because as Dr. Kelfala Marah puts it ‘government has the political will’. This move from policy to action should be grounded on addressing priority health needs and mobilizing Sierra Leoneans to improve their state of health at personal and community levels through education.
The government should embark on a national literacy crusade, aimed at addressing the problem of illiteracy. Mainstream education programs should include family life education with more content on the effects of individual behaviors, emerging infections and appropriate public responses. There should be a move for compulsory beginning and completion secondary education, which will in time manifest better health practices in the populace.
Examining the performance trend of the APC Government, under the leadership of President Dr. Ernest Bai Koroma, I am pretty sure that they have catapulted in vision of a healthy population living in environmentally sound communities empowered with a holistic knowledge of health and development. To achieve this vision, there must be strategic planning, which embodies a sense of purpose and direction that encompasses the ideals and beliefs of the citizens as a collective entity. The HIP should be comprehensive. I am confidence that once the necessary resources, both human and financial are committed, the strategies outlined in the policy will augur well toward the realization of healthcare for all Sierra Leoneans.
The factors that will determine this HIP are diverse and may be imperceptible. The causal relationship between the health status of the population and the interplay of varying social, economic, environmental, biological and psycho-social factors may also have underpinning thread. The government should be able to depend on public health institutions to develop appropriate policies, planning, and management strategies which will augment the HIP. Social and economic developments are the engines that will drive the provision of healthcare.
The growing phenomenon of urbanization in the Western Area and informal settlements has place great pressures on health and social infrastructures. Overcrowding in Freetown and its environs have led to easy spread of infectious diseases, low productivity, under-employment, poverty and other social problems. The social pressures placed on health facilities and other systems in these situations may require continuous adjustments to the health infrastructures and delivery systems, since the health needs of the population are to be met.
Indeed, the health sector will welcome government’s introduction of the HIP. It is well known that there is an association between economic deprivation and ill health. Poverty begets illness and illness begets poverty. Poverty is associated with poor environmental conditions, nutrient deficiencies, unemployment, poor health facilities and risky behaviors. When government formulates the HIP, it must go beyond the realms of health and develop strategies aimed at alleviating poverty.
Reading an article entitled ‘Health Care Reform: An Opportunity for Insurance Industry Participation in Sierra Leone’s Medical Care System’ by Mr. (or Dr.) Kortor Kamara, posted on the internet on August 5, 2008, I was very impressed by his call for an entirely private-based national health insurance plan. This call has been echoed even before he wrote that article. This means that government should privatize healthcare in Sierra Leone. It is a step in the right direction but as he said in the opening sentence of his article, Sierra Leone has inherited the socialized healthcare from Great Britain and it is still practiced. My impression is that Sierra Leone cannot radically divorce herself from socialized healthcare into privatization. It should be a gradual process. For now I believe the country needs a concrete National Health Policy as intimated by Dr. Kelfala Marah. It should be noted that less than half of the population is illiterate and poverty stricken. The populace has to be educated. Privatization of healthcare may not occur during our generation.
Indeed, the insurance industry has a role to play in this venture. They will have the challenges of designing an insurance system that will cater for the needs of the rural population who often are self-employed in farming, mining, tailors, drivers, etc.
I am optimistic that the announcement by Dr. Kelfala Marah on this venture has raised awareness that Sierra Leoneans are on the journey to enjoy affordable healthcare. However, introducing the HIP is not all. There must be ardent need to educate the populace and stakeholders on its operation, through simplified manuals, civil society organizations and the media.
The HIP will help to provide affordable healthcare to all Sierra Leoneans. Therefore, policymakers should identify national health priorities and elucidate the national health plans. Governments, the private sector and the civil society should work together to develop and implement equitable health systems that will serve the needs of all citizens, including those living in extreme poverty. The main thrust of the HIP will bring about fundamental behavioral change in the population which will tackle the growing prevalence of lifestyle related illness. Moreover, the effective implementation of the HIP holds the key to addressing the critical question of access. The provision of universal access may not necessarily translate into improving the general health of Sierra Leoneans, unless the issues of energy, health infrastructure, adequate and highly motivated health professionals as well as the provision of health equipment are thoroughly and strategically addressed. It is against these implications that the call for the need to balance access with quality healthcare is significant. The collective effort of every citizen is therefore vital to the achievement of a national health insurance policy.
By Emmanuel S. E. Leigh
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