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At a glance: Sierra Leone

Free, universal health care rolls out for mothers and children in Sierra Leone

By Kyle O'Donoghue

FREETOWN, Sierra Leone, 28 July 2010 – Early each morning, queues start to form outside the Princess Christian Memorial Hospital in Freetown, the capital of Sierra Leone. Pregnant women, mothers and young children wait patiently. Health-care workers trawl the lines for priority cases that need immediate attention.

VIDEO: UNICEF's Kyle Donogue reports on Sierra Leone's new programme of free health care for pregnant and lactating women, and all children under five years of age.


Zanaib Conteh, who is 28 and four months pregnant, is lying on a stretcher carried by her husband and brother-in-law. Having suffered a fall, Ms. Conteh is in severe pain and has sustained trauma to her abdomen. She is rushed to the front of the line and quickly receives attention from a doctor who is keenly observed by a group of medical interns.

In the past, Ms. Conteh’s husband might have waited to bring her to the hospital for fear of incurring a fee he could not afford. Today, however, things are different. “Before we would have had to go into debt,” says Ms. Conteh's brother-in-law. “But now we don't.”

Transforming the health system

There are positive changes moving through Sierra Leone's health system. In a bold move, the government recently announced free universal health care for pregnant and lactating women, and all children under five years of age.

© UNICEF/NYHQ2010-1035/Asselin
At Ola During Children’s Hospital in Freetown, the capital of Sierra Leone, women collect prescriptions for their children as part of the new programme of free primary health services and drugs for pregnant and lactating mothers, and children under five.

Still, the country’s health-care system remains under-resourced and in a state of serious disrepair following the country’s long civil conflict. Access to quality health care is expensive and difficult.

In Sierra Leone, the lifetime risk of a woman dying from complications of pregnancy and childbirth is one in eight, and 1 in 12 children still die before their first birthday. The health system is simply not equipped to deal with the country’s population of some 5.5 million.

During the announcement of Sierra Leone’s free health-care programme earlier this year, President Ernest Bai Koroma admitted the system’s past inadequacies. “Our doctors and nurses have been underpaid and overworked,” he said. “As a consequence, it became a common practice for health workers to charge vulnerable patients to make up for inadequate salaries. From today, this will change.”

Support from UNICEF and DFID

Following the announcement, women and children flocked to hospitals and clinics around the country.

© UNICEF/NYHQ2010-1037/Asselin
Essential drugs provided by UNICEF and the United Nations Population Fund line the shelves of the pharmacy at the Ola During Children’s Hospital in Freetown, Sierra Leone.

But change does not come without hard work. The roll-out of the free health care has involved months of painstaking planning. With technical and logistical support from UNICEF and funding from DFID, the UK Department for International Development, the government has created a strong supply chain for hospitals and peripheral health units, ensuring that they are initially stocked with one full year’s worth of medical supplies. 

In addition, all health workers have received substantial pay raises that serve as motivation for them to embrace the changes.

Attitudes changing

“Now that the government has taken the initiative to increase our salaries as well as other benefits, we have already started changing our attitudes,” says Dr. Michael Koroma, the administrator at Princess Christian Memorial Hospital. “We concentrate on our job and provide quality care without collecting money from patients.”

As it stabilizes, the new health system appears ready to begin delivering on its promises. Officials hope that, with increased salaries, doctors who once sought jobs outside the country will begin to return – and that a new generation of health-care professionals will be close behind, ready to fill the in gaps.



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