With Support From World Bank: Free Health Care Gets Life Oxygen

Health care in all developing countries, particularly Sierra Leone, is a massive challenge, but an achievable one.  What’s needed, according to The Voiceless Sierra Leoneans, is the will, and the funding. Despite the numerous challenges in the health sector, President Ernest Bai Koroma is credited for his Free Health Care Initiative with a full gear to achieving the Millennium Development Goals (MDGs) 4 and 5 respectively.

Indeed, the Free Health Care has been resuscitated with a ‘life oxygen’, through the introduction of the Performance-Based Financing Services (PBF), a World Bank funded Reproductive and Child Health Project, which is desperately determined to make the health facility a reality and affordable.

Following the internal monitoring tour by the Government of Sierra Leone (GoSL) via the Ministries of Finance and Economic Development (MoFED) and Health and Sanitation (MoHS), to monitor the World Bank 5.7 Million United States Dollar grant that will incentivize health workers and improve on services offered in hospital, and clinics across the country, the health sector has made considerably inroads to reducing maternal and infant mortality rate in the country.

The internal monitoring tour across the country was led by the World Bank Senior Health Specialist for Africa, who doubles as the Task Team Leader for the Performance-Based Financing (PBF) Services Technical Committee, Dr. Franciska Ayo Akala. The internal verification primarily focuses on examining the different Peripheral Health Units (PHUs) with the Basic Emergency and New Born Care (BEmONC) facility.

It could be recalled that before this time, Sierra Leone used to be the worst place in the world to give birth. On 28 April, 2010, the GoSL took a huge step in the fight to reduce maternal and child mortality rate by introducing the Free Health Scheme free for pregnant and lactating mothers and children under the age of five.

With reasonable effort from the District Medical Officer then, in Kabala town, Dr. SAS Kargbo, the Free Health Care Scheme was introduced to salvage the deplorable state of the country’s health sector.  The national introduction of the Free Health Care Scheme help to remove “user fees” up to 460,000 women and 1 million children each year benefited from such facility, devoid of political affiliations and regional background. Progress since Free Health Care was introduced has meant that: The number of women giving birth in hospitals and the number of children being treated for malaria have both tripled; The fatality rate for malaria in hospitals has been reduced dramatically, by approximately 90%; The number of children dying in the capital’s children’s hospital has halved; and free mosquito nets were and still been distributed nation-wide, to prevent malaria.

Sierra Leone, like any other developing country in the World, adequate health facility has been a serious threat to national development. In one of the Reports published by Oxfam International, “every minute, a woman with no medical care dies in pregnancy or childbirth; every hour, 300 people die of an AIDS-related illness; every day, 4,000 children die of diarrhea caused by dirty water saving the lives of nearly 4500 children”.

The aforesaid is not strange, but weary and calls for national concern. Indeed millions of people in poor countries get low-quality health care, or are forced to go without it altogether. Fees are too high, upgraded hospitals and clinics are too few, and lack of medical staff means people struggle to get treated.

 It is expected that people everywhere should be able to visit a local clinic or hospital, and get care and affordable medicines, whenever they need them.

The PBF which started in April 2011, in about 1,200 Peripheral Health Units (PHUs) was necessitated to motivate the medical personnel in order to get them more committed in their services delivered to help improve the health sector. The PHUs-PBF focuses on six key maternal and child health services. These services are: Family Planning; Antenatal Consultations; Facility Skilled Deliveries; Postnatal Consultations; Full Vaccination of Children Under One and Outpatient Consultations for Children Under Five Years. The PBF money is allocated to only the health centers that are BEmONC compliance. That is, based on quality family planning, careful deliveries and proper immunization etc, 60% is allocated for the staff, while the 40% is allocated for investment (Improving on the facility).

The PBF comprises ‘seven enablers’, among them are, inerratic electricity; proper water and sanitation; availability of blood; committed staffing; referral mechanism; functional equipment and effective drugs. The aforesaid enablers qualify a health centre to fulfill the PBF requirements.

Speaking during the verification tour, Dr. Francisca Ayo Akala admitted that the PBF is a positive step in the right direction especially for Sierra Leone.  She said with the implementation of the PBF, medical staff have been motivated to work effectively to attend to patients than ever before.

She said: “I am impressed with the work. When we started the verification, we realized that quite a number of indicators are already being met at a very high. I must state here that I did not personally talk to the patients, but from their composure, I was able to confirm that the patients were satisfied with the progress made”.

Highlighting the challenges of the PBF Program, she said the stumbling block is the way PBF is operating, stressing that the facilities are not giving enough control in terms of monitoring the number of services that are delivered. She went further to say that there is a delay in funding, while assuring that she will collectively ensure that the delay is unlocked. Such a delay, according to Dr. Akala, will frustrate the facility users.

“The way PBF works, the Facility Manager and his/her team should have much control,” she said, noting that they should be able to have an idea on how much they have performed, how much is awarded in each service and how much they are supposed to benefit in each quarter.

Addressing the Development and Economic Journalists (DEJA-SL) in Fadugu town, the Economist from the Ministry of Finance and Economic Development (MoFED) in the Local Government Finance Department, Mr. Mohamed Deen-Sankoh said his department is charged with the responsibility of fiscal decentralization, that is, transfer and mobilization of revenue in the country.

He admitted that despite the successes, there are still challenges and if not addressed, can hinder effective service delivery in the health sector. For instance, he said, generators are there, but the cost to run them on a daily basis is very expensive. He said the best way to salvage the situation is to allocate money to run those generators across the country with the BEmONC facility.

Dee-Sankoh said: “The introduction of the Free Health Care Scheme de-motivated the nurses, but with effective implementation of the PBF services, the nurses are now being motivated.”

It must be understood here that Governments of developing countries must invest in their health services. And rich countries, backed by international organizations like the World Bank, UNFPA, Global Fund and DFID among others, must solidly support them.

The Performance-Based Financing (PBF) Scheme Technical Committee started its internal verification at the Ola During hospital, the Princess Christiana Maternal Hospital (PCMH) and the Regent Health Center in Freetown, through Koribondo, Yeli, Levuma, Largo and ended at the Fadugu Health Center, Kasunko Chiefdom in Fadugu town, Northern Sierra Leone.

This is the Pen of The Voiceless Sierra Leoneans

With Elkass Sannoh

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