Transcript Free Service Delivery in Sierra Leone

The Background to Free Health Care


Sierra Leone is evolving from the status of one of the least
developed countries with the worst set of health indicators, which
includes the intolerably high Infant, Child and Maternal Mortality
Rates
One of the priorities on the President’s Agenda for Change (PRSP
II) is to address the unacceptably high child and maternal
mortality and morbidity. (An Agenda for Change, 2008 – 2012)

Current Figures
o
MMR = 875 /100,000 Live births
o
U5 MR = 140/1000
o
IMR = 89/1000
o
NMR = 34/1000
Free Health Service Delivery
In Sierra Leone
Dr. Samuel A S Kargbo
Director, Reproductive and Child Health
Ministry Of Health & Sanitation
Sierra Leone
1st June 2010
Madrid, Spain
May 2010
Background (Continued)

The National Health Sector Strategic Plan (NHSSP) aims to reach this
goal through successful implementation of the Basic Package of
Essential Health Services (BPEHS).



BPEHS specifies which services will be available at different
levels of health facilities.
BPEHS focuses on cost-effective interventions, including
emergency obstetric and newborn care, and preventive services
such as family planning, immunization and the provision of long
lasting insecticide treated bednets.
BPEHS will be rolled out over 2010 – 2011.

For this to succeed, barriers preventing Sierra Leoneans from
accessing health care must be removed.

This philosophy constitutes the basis for the FHCI
Barriers to Accessing Health
Source: National Public Services Survey 2008
Strategy for Free Health Care

On 27th April 2010, His Excellency the President launched the
abolition of fees for health care for
 Pregnant women,
 lactating mothers
 children under 5

The BPEHS constitutes the minimum set of services but ALL
other services in addition to the BPEHS are delivered free of cost
to the target population.
Defining the Needs







Brainstorm and ask:
Why do health facility staff charge for
services?
What will be the result if fees were removed?
Which resources are needed to be put in place
to prevent the ugly incidents?
How to mobilise the needed resources
Issues of Quality control
Issues of Sustainability
Ingredients for FHSD
Quality Control
Sustainability
Staff
Supplies
Structure
Supervision
Surveillance
Support
Which services free, and for whom?
From 27th April 2010,
all health services provided at government
facilities
is now free of charge for
pregnant women, lactating mothers and
children under 5 years.
Note that services already provided free of charge (including
HIV/AIDS, TB and Leprosy) will continue to be free for everybody.

Steering Committees
Governance Structure for FHCI
Presidential Reports - Progress reports sent to the Vice President’s Office on progress and areas of risk to
successful implementation with key actions which need to take place. Copies of report also sent to Ministry of
Finance.
Steering Committee - attended by MoHS heads of subcommittees and other representatives from
subcommittees. Makes key decisions on design and implementation and reviews progress against timeline
and updates from sub committees.
Tracker Tool
Gantt Chart/Project
Timeline
Subcommittees
Strategy, Vision and Governance
(Steering Group Meeting)
Infrastructure
Service
Delivery Plan
Finance
Human
Resource
Communications
Logistics/Drugs
Monitoring and Evaluation
Trends In Utilisation of Services in 6
Health Facilities in Western Area
Challenges
• Sustained Increase in demand for services at health
facilities
• Delay in arrival and distribution of drugs and other
logistics
• Theft of drugs
• Shortfalls in staff supply (no. in payroll =7,767)
• Integration of faith-based organisations & other
health care deliverers into the FHCI
• Total funding gap of US$ 8.5 Mlln
Future Plans
• Drugs sub-committee to look at longer term measures
for procurement and supply chain management
system
• Communications sub-committee to look at
clarification of messages meant for community level
• Improvement of management systems to ensure a
clean payroll
• Integration of faith-based and other organisations into
the scheme
• Set up a monitoring system (monitoring task force) of
tracking progress.
The End