The state of hospitals in Sierra Leone
Sierra Leone’s health sector takes pride in 22 referral hospitals and 1,200 peripheral health units across the country.
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The structural arrangement of the health system places responsibility on the hospitals to take care of major ailments including surgical operations, while the Public Health Units (PHUs), which include community health centres and maternal child health posts, provide basic medical services to the communities in which they operate.
Referral hospitals are manned by medical superintendents who are answerable to district medical officers. The peripheral health units are located in remote communities and are manned by Community Health Officers or Community Health Assistants depending on the population of a particular locality. Almost all government hospitals have Maternal and Child Health Aides who are being trained by medical doctors.
The current staff strength in PHUs in the country is 6,000 serving a population of three million. The staff is made up of mostly nurses and health volunteers who give a helping hand to the country’s deplorable health system.
The hospitals are understaffed as the right personnel are not posted to these hospitals. Even the sanitary condition of the hospitals is nothing to write home about.
Shortage of health personnel
The shortage of health personnel has led to the volunteerism syndrome which is visible in all hospitals in the country. Majority of these volunteers, who hold no medical qualification, step in to lessen the visible shortage of health professionals in the country.
Although medical doctors are doing their part, several specialist doctors are missing and this create a situation in which Sierra Leoneans have to travel to advanced countries such as the United States of America (USA), the United Kigndom (UK), France and countries in Africa such as Ghana to seek quality medical service for serious health problems.
Many assurances have been made by the government to improve the medical situation in the country, but the pitiful situation continues unabated.
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The Fibre Optic Cable project that has been largely discussed in the country’s media was one of the ambitious projects pursued by the government.
One of the benefits of these projects, if it materialises, is the exchange of medical knowledge and experience between Sierra Leone and countries with advanced medical services. This project is yet to come to fruition.
Sierra Leone is one of the many African countries that participated in the African Union (AU) summit in Nigeria in 2001 that led to the signing of the ‘Abuja Declaration’ in which, like other African nations, it committed itself to allocate 15 per cent of its national budget to the health sector as a way of improving the sector.
Since the government made the commitment, Sierra Leone health system has still been grappling with budget constraints which have devastating consequences on the sector.
In 2010, the sector received eight per cent budgetary allocation in 2011, it received 12 per cent, in 2012, 10.5 per cent, in 2013, 9.5 per cent and currently the budgetary allocation stands at 7.5 per cent.
The programmes manager of ‘Health Alert’ who read out these figures is of the view that the country will not attain the 15 per cent target as almost all funds are now directed to the Ebola eradication campaign.
Low budgetary allocation alongside bottlenecks in budget implementation means that the country’s health sector is not enjoying the appropriate financial requirements. This is evidenced by the lack of sufficient drugs in hospitals and personal protective gears.
Shortage of essential drugs
Mr Alie Dawoh is the health officer in charge of the Cold Room store of the government drug store at New England, West of Freetown. He said there were no rabies injection in the drug store.
He explained that in most situations, he purchased the injections and used them on victims of dog bites who frequently reported to the drug store for help. Congo Cross and New England Communities have suffered a number of dog-bite related cases and most of them have died.
Apart from dog bite- related cases, even ‘tracer drugs’, including panadol, were most times not available in the health facilities. The international community had once rated Sierra Leone as one of the countries with the highest maternal and infant mortality rate and therefore the least in the bottom ranks of the human resource development index.
Cost recovery
Government hospitals are run on a cost recovery basis as patients pay for the drugs and other health services they enjoy. In government hospitals, people pay less as compared to private hospitals. In many cases, people have argued that private hospitals provided quality service than government-run hospitals. This, therefore, explains that access to quality service is conditioned by one’s earning power.
In the government’s main health facility in Freetown (Connaught Hospital), the accommodation for the high income earners is different from low income earners. The attitudinal and behavioural disposition of health officials also scares patients from the hospitals. Nurses are less patient with their clients as they often shout at them.
The communications officer for the Health Ministry, Mr Jonathan Abass Kamara, acknowledged that nurses put on the wrong attitude towards patients although there was a code of ethics guiding the nursing profession.
“Those nurses, mostly the senior nurses who comply with the ethics of the profession, are referred to as the Florence Nightingale, the founder of nursing while nurses who flout the ethics are called the millennium nurses,” Kamara explained.
However, the nursing directorate of the Ministry of Health and Sanitation, headed by the Chief Nursing Officer, Mr Hossanatu Kanu, was working very hard to weed out some of the nurses who embarrassed patients.
Corruption in health sector
Sierra Leone’s health sector is riddled with corruption which threatens the pillars of the medical profession. Nurses’ penchant for taking bribe has been a hot topic of discussion within the public domain. It is no longer a secret that nurses demand bribes from patients, especially the beneficiaries of the free health care.
Theft of drugs from hospitals is commonplace. The Ministry of Health and civil society organisations have expressed concerns over such conduct. They say, although they have received reports of such malpractice, there is no evidence to corroborate such allegations. They are on the watch out.
However, there was a situation in Pujehun in which health officials at the Pujehun government hospitals were arrested and dragged to court for alleged theft of huge medical supplies that nearly wrecked the hospital. With the exception of a labourer who was freed, all of them were convicted, including the pharmacist.
A few years ago, a truckload of free health care drugs was impounded in Kambia, very close to the Sierra Leone-Guinea border. The drugs were loaded in a pick-up van allocated to the Kambia Government Hospital when they were about to be diverted to Guinea.
The smugglers ran out of luck as they were apprehended by Sierra Leone police officers. Whether those suspects were tried or not, only God knows. No government official has come out to say a word in respect of the arrest.
Conclusion
As it stands, The College of Medicine and Allied Health Sciences, a constituent college of the University of Sierra Leone, and few paramedical schools in the provinces produce health officials who are battling with the country’s health system.
Strong policy and legal framework for the health sector and appreciable budgetary allocation can provide the right answers for Sierra Leone’s fledgling health sector. This can be made possible if government shows strong political commitment and health officials co-operate.
Editor’s note: This publication is part of a project in collaboration with Ouestaf News with support from Osiwa.
