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Health care brouhaha – if not now, then when?

Health care brouhaha – if not now, then when?

Sit mens sana in corpore sano (a sound mind in a sound body) is a popular Latin quotation with a range of meanings, the most common as indicated above being the importance placed on staying healthy both spiritually and physically. Health comes first many will say, for it is virtually impossible for any person to function effectively and productively without being physically and mentally sound. The healthcare system in Sierra Leone is quite appalling, with most of our doctors rendering much needed medical service in foreign lands like the UK, and the US etc. One of the major reasons for the exodus of Sierra Leonean trained doctors is poor conditions of service. In the area of infant and maternal mortality in the country, Sierra Leone still faces a huge challenge and statistics in recent times show that Sierra Leone still remains one of the countries with the highest infant and maternal mortality rate in the world. Recent weeks have seen a standoff between government and healthcare workers in the country on a proposed free medical care provision for especially pregnant women, lactating mothers and children under five years. The venture to introduce a free healthcare scheme could best be described as splendid, fantastic and explicitly reasonable but a relevant question to this end is what provisions had hitherto existed or have been put in place by government to crystallize the system while also make it sustainable?

Ernest - good intentions but ...

Ernest - good intentions but ...

Independence Package


President Koroma intended to make this venture a surprise package to the nation come April 27th but this, as we have seen in the past few days has had a ripple effect on the health care delivery system with junior doctors and health workers demanding to know what their remunerations are. This stalemate resulted into frantic negotiations between government, civil society and health workers with an outcome that seemed appreciable and acceptable to the doctors at least for the time being. Indeed, health care personnel have shown how vital they are and how dependable the citizenry is on their services. The days that followed the abandonment of the hospitals saw the death and deterioration of the health conditions of many patients. The big question however is was the action of these healthcare providers necessary at this point in time or not? And if at all the government has agreed to their demands will it auger well for other government sectors who may equally want an increment or improvement of their conditions of service? An exchange with a junior doctor and one of Sierra Leone’s longest serving medical practitioner however gave a gist on the feelings of the healthcare workers in the country generally, which they claim are critical for the free healthcare scheme to succeed and for doctors especially to live a dignified life. For them, their remunerations before the proposed package for the free healthcare system was undignified, pitiable and shameful for a profession that gives so much and sacrifices so much with all the attendant risks they face on a daily basis. For instance salaries of doctors before February 2010 was less than $100 approximately Le 368,000 and because of a 20% increment, such salary was increased to approximately Le 412,000 a little over $100.

Central Pool System

One pertinent issue which the doctors put forward is the introduction of the central pool system where patients pay their consultative fees in a centralized cash office. Meaning that doctors will no longer be handling any cash and which will eventually limit them to their net (take home salaries).


This resulted to their agitation to know what was in the package for them. The categories in the package included, doctors, nurses, midwifes, support and technical staff. The gross salary of doctors (House Officers) prior to the remuneration brouhaha was Le870,000 but received approximately Le412,000 i.e., after the 20% increment. Meaning doctors were taking home less than half of their gross salaries. By implication it means that over half of their salaries were paid as tax. Thus the determination that was seen recently could not be unrelated to these dismal conditions of service and the “we go tawa” disposition they displayed. A proposed new salary scale of $600 was revealed and by curious extrapolations it meant doctors will be having a take-home salary of less than $300 a month. Thus it was further stressed for a net salary to be declared. These concerns were proved right when the net was calculated and it was concluded that doctors were to have a take home of Le1,100,000 an equivalent of $277 which doctors are to survive and depended on without their normal consultation fees. The major agitation of the doctors was to have the $600 as a non net salary (take home) which as they put it is donor money which is geared towards enhancing the success of the free healthcare programme.

Doctors are humans too

Doctors are humans too lamented a doctor who says they face so many challenges and are prone to so many risks which have resulted in fellows to lose their precious lives. Doctors and nurses, especially those who work in the operating theatres are open to suck risks as ‘Hepatitis B’ a condition that results to liver inflammation, HIV and AIDS infection sustained through needle pricks, exposure to x-rays which can result in impotence and sterility in both male and female in child bearing age, cancer etc.

Challenges of Sierra Leone’s Healthcare System

The challenges in Sierra Leone’s healthcare system can be seen from the provincial and Freetown perspectives. In Freetown, hospitals are often without adequate water supplies even in the operating theatres, electricity often fluctuates, indiscipline and insubordination by junior workers is often a problem, extortion by nurses and the lack of periodic in-service training to keep doctors and nurses fresh is lacking. In the provinces, there is often conflict between the District Medical Officer (DMO) and doctors in charge of the hospitals. DMS’s often have access to fleets of vehicles which are often under their control while the doctor in charge can only boast of an ambulance that is, where it exists. Drug supply is most times lacking or not available on time. Housing is also sometimes a problem.

Well Intentioned President

It is obvious that President Koroma is well intentioned in striving to introduce a free healthcare scheme for the country’s most needy people. It was in this vein that he deliberately engaged partners like the African Governance Initiative (AGI) the brainchild of Britain’s former Labour Prime Minister, Tony Bliar, UNICEF and the British Department of International Development (DFID). The scheme includes the procurement of drugs for nationwide distribution and is part of 51 million dollars secured by the Government of Sierra Leone from DFID. The drugs will be distributed by UNICEF to all medical facilities in the country and is expected to last for six months. This must however be done with consideration to the current economic condition of the country. Relying on donor support for such a venture might seem unproductive in the light of dwindling donor support in the future. Let us however look at the brighter side of life and see where the future takes us. If not now then when?

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