Sierra Leone: An ambitious health reform and a weak state capacity

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Free health care initiative for pregnant women, breast-feeding mothers and children under five years old has begun in Sierra Leone; a government attempt to address the country’s health service fees and cost of medication that resulted in alarming maternal and child death rates.

While most Sierra Leoneans have expressed joy at the health reform, experts say that the country — one of the world’s poorest — lacks the resources and infrastructure to support the new program.

According to reports, medical equipment has been ordered and some drugs distributed around the country, but Sierra Leone’s United Nations Population Fund representative, Ratiszai Ndlovo said that everything was still not in place for the launch of the healthcare plan.

“It’s not perfect, it’s not 100%. But I think we cannot start the program with everything in a perfect condition,” Ndlovo was quoted as saying.

The health program is being funded mostly by the UN and the UK, who have already refurbished hospitals, supplied drugs and paid health workers’ wages.

The free healthcare in Sierra Leone is projected to save the lives of more than one million mothers and children, at an initial cost of $19m (£12m). But some Sierra Leoneans have questioned how the free healthcare will be funded once the UN and UKs support runs out.

In March, health workers in the West African country staged a two-week protest against the health care reform; expressing such grievances as pay and working conditions.

Reports say the health care workers feared the reform would result in more patients and longer working hours. Some argued that the country’s roads were in terrible conditions and that there were few ambulances to operate with, which means pregnant women living on the outskirts of towns or in the country could not get urgent attention.

Before the health reform was passed into law, the government offered salary increases of between 200% and 500% to health workers, and Sierra Leone joined other African countries such as Burundi with a free care to new mothers and children under five in recent years.

Sierra Leone emerged from a decade of civil war in 2002, but reconstruction has proven to be a slow process.

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