The Background to Free Health Care

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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 Presidents 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
• MMR 875 /100,000 Live births
• U5 MR 140/1000
• IMR 89/1000
• NMR 34/1000

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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

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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

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Barriers to Accessing Health

• Source National Public Services Survey 2008
•  

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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.

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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

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Ingredients for FHSD
Staff
Supplies
Structure
Supervision
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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.

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Governance Structure for FHCI

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Trends In Utilisation of Services in 6 Health
Facilities in Western Area
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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

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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.

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The End