Storm clouds gather over the
city, forks of lightning flash in the night sky and rumbles of thunder roll
across the estuary like distant drums, a warning of the approaching rains. As the dry season comes to an end, the damns
remain low and power shortages add frustration to the daily grind; the humming
of generators are heard across the city each evening bringing electricity to
those that are able to afford fuel.
As the dry season ends, so too
does the first year of the President’s post-Ebola Recovery Programme, launched
last July. The first nine months were
focused on getting to and maintaining zero cases, restoring access to basic
healthcare, re-opening schools, providing social protection support and
revamping the economy. Many of these
objectives have been achieved, some are still a work in progress. The next phase has begun; the 10 to 24-month
period which is about re-invigorating the private sector, creating jobs and
improving infrastructure. There is also
a major focus on building a resilient health system. This will be a herculean task and there are
some promising early signs but there is much hard work to be done. All this also comes at a time when the World
Health Organisation has launched the Sustainable Development Goals (SDGs) to
end poverty and ensure prosperity for all.
Goal 3 focuses on good health and well-being including universal health
coverage and access to quality health services.
Goal 3c specifically aims to “increase health financing and the
recruitment, development, training and retention of the health workforce in
developing countries”.
Here are a few facts that
illustrate the health situation currently.
Sierra Leone has a population of 7 million, sixty percent of whom live
below the poverty line, living on less than $1.25 per day with a 40% literacy
rate. According to World Bank data, for
every 100,000 live births, 1,360 mothers die of pregnancy related causes in
Sierra Leone whereas in the UK the figure is 9.
Similarly, for every 1000 babies born 120 will die before the age of
5. There has been progress here as the
figure was 150 per 1000 four years ago.
In the UK, the child mortality rate is 4 per 1000. Maternal health is a good indicator of the
functioning of the healthcare system as a whole as they are dependent on services
from the community level through to specialist care. Social and cultural factors also play a part
in this; gender inequality and education impact on whether a woman is able to
seek appropriate antenatal and emergency obstetric care. Although Sierra Leone is towards the bottom
of the UN development rankings, these problems are shared by many other low
income countries across Africa and Asia.
The estimated expenditure on
health is $86 per capita, of which 60% is met by the patient. In comparison,
the UK spends just under $4000. There are only around 200 doctors in the whole
of Sierra Leone and 288 midwives, the majority of whom are based in the Western
Area close to the capital. 64% of skilled health worker posts are vacant across
the country and there is a major shortage of more highly-skilled nurses. It is estimated that just under half the
workers are currently unsalaried. This
means that not only are they not payed, but many are unregulated.
Human resources forms one of the
WHO core components of health systems and a workforce that is motivated and
adequate for the population it serves is an essential part of a health system
strengthening strategy. This blog post
stems from my recent attendances at a Health Ministry summit on human resources
and the annual West African College of Physicians Scientific Meeting where many
of these issues have been highlighted and discussed in depth. The government and senior medical figures are
well aware of what the problems are and are working hard to improve the
situation.
So what is the country doing to
address some of these problems and what are the potential solutions? It will be necessary to increase the number
of staff on the payroll, training will need to be improved at all levels,
across all cadres of health worker and stronger governance and regulatory
systems will need to be introduced. Task
shifting, whereby less skilled workers are utilised to provide certain
services, will be important in this process.
Community Health Officers are already being trained to conduct surgical
procedures in certain health facilities.
Strong leadership will be required and partnership working will be
essential to achieve the targets set.
Health workers will also need incentivisation to stay in the system and
not leave the country to work elsewhere.
This will not only require adequate remuneration and supervision but
also defined career pathways, professional development and the resources and
facilities to enable them to do their jobs properly. Adequate infrastructure is required in terms
of clean water, electricity and a supply chain to ensure that clinics can
function effectively. The discrepancy
between urban and rural staffing levels will need to be ironed out and recruitment
streamlined and decentralised so that workers may be employed more
quickly.
In the last 6 months, a teaching
hospital bill has been passed by parliament which will give hospitals like
Connaught more autonomy in governance.
They will be able to recruit and manage their own staff and have more
independent decision making over how the organisation is run. Post-graduate medical training is developing;
several months ago I mentioned that the hospital had an accreditation visit
from the West African College of Surgeons.
This was successful and the hospital is now able to provide basic
surgical training. The long term goal
will be to have doctors that are able to complete speciality training without
having to work abroad in all the major specialities.
It will take years and
significant investment to train the extra health workers required but I have
noticed positive changes even in the last nine months. King’s is in a fortunate and privileged
position to be able to contribute to these changes. By working with the Ministry, teaching hospital
and college of medicine and allied health sciences, we are able to contribute
towards policy development discussions, training and the support of
post-graduate specialisation. It is a
time of great change and transition. My
time here is short and KSLP are currently recruiting for an emergency physician
to take my place, I would encourage anyone reading this with the requisite
skills to apply and be part of the journey to recovery and prosperity.
Healthcare workers at Connaught. Without adequately trained staff, a health system will not function effectively.
