Free Healthcare has come for the under 5s and pregnant and new mothers

You will have seen earlier in the blog that Sierra Leone has some of the world's highest maternal and child death rates.

On 27th of April, Independence Day in Sierra Leone, the President announced that going to the doctor will become free for children under five and pregnant women, and new mothers. The new plan will save lives as many have died because they were unable to pay health service fees and the cost of medication. In a country where life expectancy is 46 (men) and 49 (women), one in eight women risk dying in pregnancy or childbirth, and for every 1,000 children born, 140 die. Indeed it has the highest mortality rate in the world for children under five.

The programme's main donors have been the UN and the UK and there have been some teething troubles.
Ratiszai Ndlovo, Sierra Leone's UN Population Fund representative, told the BBC that although medical equipment had been ordered and some drugs distributed around the country, everything was still not in place at the launch of the healthcare plan.

"It's not perfect, it's not 100%," she said. "But I think we cannot start the programme with everything in a perfect condition."




In this video, Sunkari Conteh describes how her baby died because she could not afford the £15 fee that the doctor who visited her was charging. Although the problem here is seen as poverty, the training that our healthcare team provided in March could have shown how the problem could be solved without outside medical involvement.

Other problems in making free healthcare a reality have included:

• Pay and conditions which produced a two-week-long strike in March staged by the country's public health workers. They feared free care would result in more patients and longer working hours. The dispute was settled when the government offered salary increases of between 200% and 500%.  It appears that the Free Care Initiative has done well on salaries and stopping direct fees, but drug distribution is still inadequate at present.
  
  
  
  The entrance to the Children's hospital, Freetown

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 Freetown. Her observations of the implementation of the programme have included -

• Crowd control.  "As the only paediatric hospital in the country, with a huge deprived population on our doorstep, the children’s hospital was always going to find itself very popular once user fees were removed. Nonetheless, I have to admit that I froze, my heart in my mouth, as I swung through the gates on the first day and saw the throng of mothers filling the car park. But we hadn’t quite foreseen how large the crowd would be or how keenly they would press on the doors. Our few security staff were taken by surprise and found it hard to cope."
• Sheer numbers. "Some people brought kids who were not sick; some apparently believed that talk of a “basic healthcare package” meant that they would, literally, be given a package of goodies if they attended. Some believed that they needed to register before a certain deadline to be able to use the free services in the future."
• Cheating.  "Someone was arrested for selling drugs obtained by taking the same child to several health facilities."
• Prioritising. "The hospital and its staff can only provide care of any quality to a certain number of patients per day.  We decided that we had to start going through the queue and, based on WHO criteria, start sending only the “priority” cases inside and advising the “routine” cases to go to their local health centre. Emergency cases went straight up to the ER as usual.  It wasn’t easy. These are people who might never have brought their children to government health services before because of the fees. And now they’re being told that they can’t come in to the hospital."

If you would like to read more about Dr. Spry's work, please go to   http://blogs.bmj.com/bmj/category/emily-spry/

• There have been problems distributing the correct drugs in the right quanties. However, with the help of the Sierra Leone government, donors and partners, more than £6,745,000 worth of drugs have been distributed to the 1200 Primary Healthcare Units and other health facilities in the country. Completing such a task in a country that still suffers under poor infrastructure will not be easy.
• Sierra Leone's bad roads and the lack of ambulances means pregnant women living in the more isolated parts of the country are often slow to receive attention.