Notes from the Field: A Summer in Salone

| February 1, 2012 | 0 Comments

By Nigel Deen

In April 2010, the government of Sierra Leone declared that all healthcare services for pregnant and lactating women, and young children be free of charge, in response to the high maternal and infant mortality rate. The government of Sierra Leone launched the Health Sector Strategic Plan 2010-2015 to ensure successful implementation of the Basic Package of Essential Health Services (BPEHS) to improve service delivery.

I managed to travel around Sierra Leone quite a bit. Visiting Sussex Beach during the rainy season, I found that the beaches become flooded making it hard to walk in but providing beautiful scenery. (Courtesy of Nigel Deen)

According to the government, this package ensures the provision of minimal essential quality of care for all and includes services that have the greatest impact on major health problems (especially that of maternal and child health).

Last summer, I traveled to Sierra Leone to assess the success of the Health Sector Strategic Plan with respect to maternal health. My research focused on two key issues that prove especially important in reducing maternal mortality rates.

The first goal was to evaluate the availability of maternal health resources. In order to assess the quality of the maternal healthcare, I travelled to maternal facilities in Sierra Leone and evaluated the medicines, staff, equipment, and utilities available at each of the facilities. Additionally, I interviewed pregnant and post-partum women at these facilities to find out more about their experience with maternal care.

The second goal was to conduct interviews with healthcare officials and health workers to determine the challenges that exist in providing health services to pregnant and post natal women.

I went to Sierra Leone with the intention of interviewing at least 100 women and by the end of the first week I was successfully able to interview 30. I was accompanied by another Harvard undergraduate and a family relative, Mohammed; having their support was invaluable and allowed us to cover ground more quickly.

When visiting these hospitals I was amazed at the level of care expected despite the scarcity of resources. Medicines for the women are few and far between, and women often have to wait hours in the heat for antenatal checkups that rarely go on for more than ten minutes. Additionally, the pay for hospital staff is mediocre, further de-incentivizing professionals to remain in the industry.

After reviewing interviews with these women, it is clear that pregnant women in Sierra Leone must overcome many barriers in order to receive basic maternal care. These barriers can be classified into physical access barriers, community barriers, and resource barriers.

Alone, each obstacle did not exclusively affect a woman’s chance of survival; rather, they each played an integral role in triggering the series of events which determined healthcare quality for pregnant women in Sierra Leone. Many women did not go to school and almost all live in abject poverty, depicting the immense impact social determinants have on health outcomes for women. Most women didn’t own a flushing toilet and didn’t know that they shouldn’t cook outside in the vicinity of a pit latrine.

While healthcare officials and health workers are passionate about the work they do, they are discouraged due to a lack of adequate support. They often go without electricity for many hours a day; many doctors fear that they will have to deliver babies by candle light.

Without air conditioning pharmacists believe that the drugs will denature and be rendered useless. A lack of space in most of hospitals means that the few neonatal wards must be converted into delivery rooms while also serving as storage rooms for medication.

Amidst all the shortcomings, there does seem to be a glimmer of hope. Based on my findings, the free maternal healthcare policy is effectively convincing women who would normally give birth at home to give birth at a clinic or hospital.

The West Africa Fistula Foundation in Bo, Sierra Leone: a women’s health program dedicated to reducing maternal mortality caused by obstetric fistula through providing access to education and medical remedies. (Courtesy of Nigel Deen)

The challenge however remains twofold: (1) to regain the trust of those who continue to visit Traditional Birth Attendants (TBAs) despite having access to free care, and (2) to help support the hospitals so that they are able to provide for the increase in patients without compromising service quality. These objectives require money that Sierra Leone does not have, or has not allocated for this purpose.

While it is true that the policy has effectively increased the number of women who are now delivering at hospitals despite these barriers, it remains to be seen as to whether or not this policy is sustainable for the hospitals. The increase in pregnant women attending hospitals, without an increase in the number of facilities and improvement of conditions, has placed a tremendous amount of strain on doctors, nurses, and hospital staff.

The Sierra Leonean government cannot afford to lose the gains it has made in maternal health and must stage a second effort to bolster the healthcare resources in the country. Whether or not this means accepting outside aid, or incurring debt, it is an investment that must be made in order to positively influence the health outcomes of the Sierra Leonean women and children.

Category: Spring 2011, Student Submissions, Women and Children

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