Sierra Leone: mothers and babies in danger
UNICEF responds to lack of healthcare in Sierra LeoneFreetown, Sierra Leone, 9 October 2009 - It is past midnight at the Koinadugu Maternal Ward. A woman having a difficult labour is brought in. She looks hopeless.
Her family is crying; fearing for the worst. The woman has to be operated. Fortunately the operation is successful and she gives birth to a healthy baby girl.
Another woman, brought in the following night, isn’t as lucky. She dies just minutes after giving birth to a baby boy.
Doctors say her death, like most pregnancy-related deaths, is due to bleeding.
Blood, a must in such situations, is unaffordable to the average family.
In a country where two-thirds of the population live on less than $ 1 a day, a unit of blood costs $ 30 due to a serious lack of blood bank facilities.
Blood is even more expensive at night which is when most of the late pregnancies stream in.
Several development reports, notably the UN Human Development Index, consistently indicate that Sierra Leone is one of the worst places in the world for a child to be born and for a woman to be pregnant.
According to the Sierra Leone Multi Indicator Cluster Survey conducted in 2005, as many as 1,300 of 100,000 women die during delivery while 159 of 1000 children die before they turn five.
These grim figures are a result of poverty and deprivation, partly caused by the decade long civil war, which destroyed the health infrastructure.
According to a nationwide assessment on Emergency Obstetrics and Newborn Care (EmONC) undertaken in 2008 by the Ministry of Health and Sanitation and UN agencies, the state of maternity services for labour and delivery purposes is poor trough out the country.
This is because there is a serious lack of both physical facilities and human resources and the fees charged for services are too high. One woman explained: "When we go to the hospital, we are not treated because we don’t have money. They ask us to pay Le20,000 (ca 6 US$). If you don’t, you will not be given medicine."
Dr. Rumishael Shoo, UNICEF Chief of Child Survival and Development in Sierra Leone, confirms: "Cost is the most significant barrier to utilization of health services."
Another reason for the extremely low utilization of health facilities is the lack of trust in health facilities opposed to the trust in traditional birth attendants.
Urgent needs for staff and equipment
For example in only 2 % of community health centres deliveries are performed by trained midwifes, and only 5 % of the facilities have pediatricians.
Most deliveries are performed by traditional birth attendants (TBA), who are unskilled and do not make timely referrals for difficult cases.
There is therefore an urgent need for trained and qualified midwives, medical officers, maternal child health aides and nurses.
"The most urgent need is for staff that can do basic life saving things such as give injections", says Dr. Shoo.
Another serious problem facing the health sector is the lack of an ambulance service and communication for referrals.
Most health facilities do not have the equipment or human resources for the care of preterm or low birth weight babies.
Also shortage of such basic utilities as water, electricity and transport for the delivery of maternal and child health services is commonplace.
Only 10% of hospitals & clinics, mainly in the three regional headquarter towns and the capital Freetown, have reliable electricity supply, making especially night-time work very difficult.
These shortages leave emergency rooms, laboratories, labour rooms and operating rooms almost unusable.
UNICEF responds to shortages
UNICEF distributes essential drugs and other supplies for emergency obstetric care to hospitals across the country, trains health personnel and gives logistic support for monitoring and evaluation.
UNICEF also supports the delivery of a minimum package of essential preventive, promotive and curative health services at the level of the health facilities, at national and district levels, for children under five years and women of child bearing age.
In addition to that, UNICEF supports a community-based approach to reducing infant and young child mortality and improving overall child health.
Mothers and children receive health and hygiene education, including information about the importance of handwashing with soap, exclusive breastfeeding, nutrition and malaria prevention.
Parents are also trained to treat infections in newborns and how to respond if a newborn stops breathing.
One of the beneficiaries is Sinnah Kamara, a young mother in Bombali district in the northern part of the country.
She has two healthy children, but she knows how fragile the changes of survival are for a child in Sierra Leone.
“My sister lost her two year old son to malaria”, she recalls. Sinnah seeks regular advice from the health centre to keep herself and her children healthy.
UNICEFs acts to improve maternal and newborn health are expected to save the lives of mothers like Sinnah Kumara and their newborns and give them a chance to a healthier future.
By Umaru Fofana and Karolina Roiha