FREETOWN, Sierra Leone — Barack Obama isn’t the only president facing opposition to a new health care plan.
Today, to mark Sierra Leone's 49th anniversary of the country's independence from Britain, President Ernest Bai Koroma is launching a free health care program for women and children, but lack of funds and a strike by medical workers at the government hospital, nearly put the initiative in jeopardy.
The free health care program is an effort to improve Sierra Leone’s maternal and infant mortality rates, which consistently rank among the worst in the world. The infant mortality rate is 89 deaths per 1,000 births and the maternal mortality rate is 857 deaths per 100,000 births, according to the nation’s 2008 Demographic Health Survey. One in seven Sierra Leonean children die before reaching age 5.
In comparison, the infant mortality rate in the United States is seven deaths per 1,000 births and the maternal mortality rate — although on the rise in recent years — is 13 deaths per 100,000 births.
To improve the health of infants and mothers here, Koroma — with the help of donor organizations, primarily the U.K.’s Department for International Development (DFID) — is launching the program to provide free health care to children under 5, and to pregnant and lactating mothers.
DFID is providing $70.5 million to Sierra Leone under a 10-year Reproduction and Child Health Care plan. From those funds, $22.6 million will be used to fund the free health care program over the next three years. UNICEF has already received $7 million in DFID funds to provide medicines under the program to combat illness and conditions such malaria, diarrhea, diabetes and hypertension, which often affect pregnant women.
Koroma had a tough time selling the plan, which he and the ministry hoped to unveil to much fanfare next month. Details of the plan remained under wraps until health care workers and local media began asking questions.
The trial and conviction of the minister of health and sanitation on corruption charges fueled more public nervousness about the implementation of the much-needed services. The nation’s vice president and deputy health minister are currently filling the role of the health minister until a new one is named.
Medical workers say the idea behind the health care initiative is a good one, but there is not enough equipment, supplies or even staffers available to handle the flood of women and children expected once it goes into effect.
Nurses, who declined to provide their names for fear of retribution, say the public is already confused, with people coming to hospital demanding free care.
The average nurse at one of Freetown’s two government hospitals makes about $50 a month. A doctor makes about $100. They say they often use their own money to purchase latex gloves so they don’t put themselves at risk for infections and diseases such as HIV/AIDS when working with patients, who are typically at high risk for such diseases.
The pay isn’t enough to cover basic needs such a rent and food, the nurses said. A large bag of rice costs up to $30.
“I am fairly convinced and my government is convinced that most of the issues raised as your concerns are justifiable,” said Koroma during an address to more than 200 striking medical workers last month. “I take full responsibility. If there was earlier engagement and consultation … maybe we wouldn’t be where we are today.”
The three-week strike ended at the end of March when the government agreed to double the salaries of health workers.
Military doctors and nurses were manning the two government hospitals in Freetown during the strike. The military doctors did everything from the emergency room cases to the dressings of wounded patients, according to Lance Cpl. Tengbeh John.
Sierra Leone’s annual budget for medical workers’ wages is $6 million, but will increase to $12.5 million, in order to double individual salaries.
There’s still a shortfall in the overall monies needed to implement the plan and the Koroma government has gone back to the donor community to solicit $11.2 million more.
“We received $4.6 million, but there is still a gap,” Koroma told medical workers at the time. “It’s a special condition for a special group to provide special services to save mother Sierra Leone.”
To date, it’s still unclear how much of a shortfall the government has to make the health plan a success.
Charly Cox, technical assistant for the Ministry of Health and Sanitation said staffing is just one part of overhauling the nation’s medical system, but hospitals also need “electrification and running water, equipment and drugs.”
“We are very pleased that (the medical workers) have gone back to work,” she said. “This is an opportunity to turnaround the health sector in Sierra Leone.”
Cox said the health care initiative goes beyond simply offering workers a raise and opening the gates to women and children. The ministry is sending medical workers to other West African nations for additional training and to learn best practices for administering care.
“There’s a huge amount of other stuff going on behind the scenes,” she said. “We want it to be free and on the way to a higher quality health care system.”