Document - Sierra Leone: Investment in the health sector needed to implement free care policy



AI Index: AFR 51/014/2009

16 November 2009

Sierra Leone: Investment in the health sector needed to implement free care


On 18 and 19 November 2009, the Government of Sierra Leone will hold an Investment and Donor Conference in London. During the conference, the government is expected to call for additional donor funding amounting to $20.1 million per year to implement its free healthcare strategy for pregnant and lactating women and children under five.

Sierra Leone has one of the highest maternal mortality rates in the world and the cost of healthcare constitutes a major barrier to women’s realization of the right to health. The announcement of free healthcare for pregnant women as well as the strategy for implementation, from April 2010 onwards, would be a significant step in efforts to reduce maternal mortality rates in Sierra Leone.

However, momentum built by the government’s actions will need to be matched by more financial and technical support from the international community. “The donor conference is the perfect opportunity for the international community to show they are committed to supporting Sierra Leone in its efforts to reduce maternal mortality by ensuring there are enough resources to make free care for pregnant women a reality,” said Tania Bernath, Amnesty International’s researcher on Sierra Leone.

Since 2008, the government has made efforts to address issues surrounding barriers to maternal healthcare. In February 2008 President Koroma endorsed the Reproductive and Child Health Strategic Plan (RCHSP), committing the government to reducing maternal and infant mortality rates by 30 percent by 2015. Since then, the government has recruited a new director for the reproductive health unit within the Ministry of Health. Together with UN agencies the Ministry of Health conducted a needs assessment which showed that six of the country’s 13 districts had no emergency obstetric facilities. In response, UNFPA and Ministry of Health, through pooled funding from donors, are working to provide comprehensive emergency obstetric services in these districts.

Efforts have also been made to combat corruption in the health system. In 2008, the Anti- Corruption Commission published a report Recommendations for Reform: Towards a Better Health Care Delivery System covering a number of key issues to be addressed by the Ministry of Health. On 4 November 2009, the Anti-Corruption Commission charged the Minister of Health on three counts of corruption; he was subsequently removed from his post.

Empowering women to claim their right to health is also essential to reducing maternal mortality; the low status of women in Sierra Leone has a direct impact on the priority placed upon meeting their healthcare needs. Given their lack of independent financial means, women are often unable to decide for themselves to go to a healthcare facility for family planning services, antenatal services, delivery or emergency care. Delays in the decision to seek medical care, delays in accessing care, and delays in receiving care lead to complications and ultimately high maternal deaths.

On 13 November 2009, Amnesty International, through its Sierra Leone section, presented more than 80,000 petition and postcard signatures collected over two months from people around the world, encouraging the President of Sierra Leone to continue making maternal health care a priority. This includes allocating 15% of the budget to healthcare in accordance to the Abuja Declaration, ensuring hospitals are better supplied and medical staff paid adequate salaries, among others. The conference serves as an opportunity for both the government and international community to strengthen their commitment to address all factors-both direct and indirect-that contribute to maternal mortality in Sierra Leone.


On 22 September, Amnesty International launched a report Out of Reach: the cost of maternal health in Sierra Leone (AFR 51/005/2009) and campaign to reduce maternal mortality in Sierra Leone. The report examines the underlying causes behind high maternal mortality rates in Sierra Leone which is due to a combination of factors including lack of access to healthcare due to high cost and fear of cost, poor referral networks, lack of trained medical staff and insufficient drugs and medical equipment. Other causes include discrimination against women and social factors that contribute to undermining women’s right to health, and the lack of accountability at different levels of the health care system to ensure availability, accessibility, acceptability and quality of health care services.

The Sierra Leone Donor and Investment Conference on 18 and 19 November 2009, is being hosted by His Excellency Ernest Bai Koroma, President of Sierra Leone, the UK Minister for International Development and the World Bank Vice President for Africa. Preliminary meetings will be held on 18 November with the main meeting on 19 November when the Government of Sierra Leone will present its new Poverty Reduction Strategy II: Agenda for Change. During this session, funding requirements and priority areas for government and donor interventions will be identified for a three year implementation period.


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