Sierra Leone’s healthcare system is facing major challenges; it is still in a terrible state, even after the Ebola crisis created major public exposure of its decadent and rotten nature. Hospitals, clinics, and community and peripheral healthcare posts are running bare of essential tools and professional medical practitioners. Many do not even have medicines to provide for those in desperate need. Infant and maternal mortality is extremely high, and more and more people are dying of complications in healthcare centres because of a lack of adequate resources and skilled practitioners across the country. Before Ebola struck, there were less than 300 qualified medical doctors in the whole of Sierra Leone. This figure was drastically reduced to just over 200 after the epidemic killed several of them.
Practical Tools Initiative’s intervention is part of a large-scale medical training resources drive over the next five years to improve standards in teaching of and performance by medical practitioners in the country. As part of this drive, we also send British medical volunteers to work with community clinics and hospitals.
The major contributing factors to the downward spiral in the provision of good healthcare services in Sierra Leone are neglect, the familiar corruption, and state incapacity to prioritise training of national medical professionals who can deliver the government’s vision.
Neglect is at the centre of what the healthcare system is facing in Sierra Leone. Many community hospitals, maternity clinics and healthcare posts are left in a state of decay, with rusty and dysfunctional equipment. Rickety trollies, mouldy ceilings, and broken or uncleaned lavatories with no water supply are common sights in Sierra Leone’s medical establishments. Wobbly and broken hospital beds are still used by midwives to deliver babies. Some of these institutions do not even have electricity to keep medicines under controlled temperatures.
The Ebola crisis exposed Sierra Leone’s appalling healthcare system and led the international community to pour funds into the country to support the failing services. This, unfortunately, became the new frontier for ‘poverty pimps’. It also became a new frontier for extreme corruption by some in public offices within the system – these people diverted the most-needed equipment and medicines to run their own private clinics, pharmacies and home treatment services for patients. Home treatment for patients is rife in Sierra Leone and is undertaken by the very medical professionals who are supposed to uphold and maintain government-run medical centres. Patients who go to government hospitals are quickly persuaded by doctors and senior nurses to return to their homes and be treated there privately with medical equipment and medicines allegedly stolen from government-run hospitals. Payments for such treatments goes directly to the doctors and nurses outside of the government-run system. Patients are also referred to private pharmacies run by relatives or associates of medical practitioners who mysteriously acquire the necessary medicines. This is so common that even simple examination gloves, tags for newborns, and umbilical clamps are not available in some government-run clinics and hospitals! This is what is destroying Sierra Leone’s healthcare system.
We have had desperate field nurses coming to us to ask for these things because they do not have them in community maternity centres. They are the hard-working ones who care about their communities. In a small community clinic in Manowa town, Eastern Sierra Leone, there is a young community midwife who was posted there about four years ago and has not been paid since!
Additionally, the state’s inability to prioritise the training of national medical professionals capable of delivering the government’s vision of bringing adequate healthcare services provision to desperate communities is shocking. We work with hospitals, clinics, and health posts through the provision of medical equipment, medicines, and cutting-edge textbooks for medical training institutions across the country. In 2018 alone, we delivered nearly $500,000 worth of new and relevant medical textbooks to five government medical training centres across the country. In 2019, $800,000 worth of new cutting-edge medical textbooks will be delivered to government medical training institutions in the country.
We continue to work independently. We will also continue to maintain the high standards that we have set for ourselves.
The key to our successful programme of supporting institutions in Sierra Leone is the effectiveness of our monitoring mechanisms. Our experience in the east of the country shows that targeted deliveries of resources, followed by a comprehensive monitoring system, leads to improved performance.
The process of preparing the books for delivery is similar to how we work with schools. The difference, however, is the extra vigilance needed, especially where expensive medical textbooks are concerned. The books are stamped with our logo on several prominent pages. In addition, we conduct systematic reviews and audits to ensure that resources are available for all to use.
We provide hospital hardware such as beds, examination couches, and other medical equipment. Our delivery and monitoring mechanisms in Sierra Leone have been so effective that the resources we give out are making great progress in transforming healthcare centres.
We have encountered some challenges too. For example, Njalah University’s Community Health Sciences department (formerly known as Para-Medical), which received a large quantity of high-value new medical textbooks as part of a massive drive to improve the training of medical practitioners in the Southern Region, failed to display the resources in their library for over one and a half years! Whilst all other medical training institutions have displayed their new textbooks and made it possible for medical students and researchers to access them, Njalah University failed to follow suit until we challenged them.
It is absolutely gut-wrenching to see this. Educational deprivation – where those in power deliberately deny access to those in need – was a key contributor to the Sierra Leone civil war. This attitude, unfortunately, has not changed in most (if not all) state-run training institutions. This has destroyed, among other things, the country’s healthcare system.
We stand firm and hold individuals and institutions accountable. This is why our interventions are very effective.