Healthcare in Sierra Leone is provided by a mixture of governmental, private and non-governmental organizations (NGOs). The Sierra Leone government has divided the country into 13 health districts based on the administrative districts of Sierra Leone. There is a lack of healthcare facilities in the country as a result of the Sierra Leone Civil War but have been gradually reconstructed since the end of the war.
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All medical care is generally charged for in Sierra Leone[1] and is provided by a mixture of government, private and non-governmental organizations (NGOs). There are over 100 NGOs operating in the health care sector in Sierra Leone. The Ministry of Health and Sanitation is responsible for organising health care and after the end of the civil war the ministry changed to a decentralised structure of health provision to try to increase its coverage. The country is divided into 13 health districts that correspond to the districts of Sierra Leone except for the Western Area Rural and Western Area Urban districts which are combined into the Western Area Health district. Each district has a health management team and an average of 50 peripheral health units (PHU) and over 100 technical staff. The management team is responsible for planning, organising and monitoring health provision, training personnel, working with communities and supplying equipment and drugs.[2]
The PHUs are designed to be the delivery point for primary health care in the country and there are three main types. The community health centre carries out health prevention measures, cures and health promotion activities and is in charge of overseeing the other PHUs in the area. It is planned that each chiefdom, the unit of local government in Sierra Leone below the level of district, should have at least one community health centre. Community health posts perform a similar function to community health centres but have fewer facilities and are used to refer patients to the health centre or the district hospital. Maternal and Child Health posts are the first level of contact on the ground and are located in smaller towns of with populations between 500-2000. Much of the health care infrastructure was decimated during the Civil War and the health service is still in the process of being organised with hospitals and PHU being rebuilt or created and staff being trained. [2]
Public health in Sierra Leone is generally poor and in 2007 the country had the highest level of child mortality in the world.[3] Other indicators of health are also poor with the infant mortality rate of 123 deaths per 1000 live births in 2009 and a life expectancy of 48 years. The situation in relation to public health has been improving since the end of the civil war in 2002. For example child mortality has decreased from 302 deaths 1000 per live birth in 1990 to 192 deaths per 1000 live births in 2009.[4]
The country suffers from epidemic outbreaks of diseases including yellow fever, cholera, lassa fever and meningitis.[2] The prevalence of HIV/AIDS in the population is 1.6 percent, higher than the world average of 1 percent but lower than the average of 6.1 percent in Sub-Saharan Africa.[5]
Maternal mortality statistics in Sierra Leone are among the world's highest. One in eight women risks dying during pregnancy or childbirth.[6]
In April 2010 Sierra Leone launched "Free Health Care Medical Insurance", a system of free healthcare for pregnant and breast-feeding women and children under five.[7][8] A UN population Fund representative said that medical equipment had been ordered and some drugs distributed as part of the new healthcare scheme but the coverage was not yet 100%.[8] The initial set up cost of the scheme was $19 million and it is expected to save the lives of more than a million mothers and children.[8] Healthcare workers had gone on strike over the plans in March 2010 arguing that free healthcare would increase their workload and working hours, the government settled the dispute with pay rises of 200-500%.[8] The program was officially launched by President Ernest Bai Koroma on 27 April 2010, the 49th anniversary of Sierra Leone's independence from the UK.[9]
The scheme is funded mainly by the United Kingdom and United Nations who have paid to refurbish hospitals, supply drugs and pay healthcare professionals' wages.[8] The UK alone has agreed to pay for a years worth of drugs for the program and the World Health Organization has provided blood banks in each major town.[10] The British government's funding came from the Department for International Development (DFID) and amounted to $22.6 million to fund the scheme for the next three years from a total allocation of $70.5 million for the 10-year long "Reproduction and Child Health Care" plan.[11] UNICEF also received $7 million from DFID to provide medicines for pregnant women.[11]
Traditional medicine forms part of the primary health care system in Sierra Leone. The traditional medicine programme, run by the Ministry of Health and Sanitation, has constructed a training school at Makeni, a healing centre at Kono and conducted workshops to promote co-operation between traditional medicine practitioners and orthodox doctors. Members of the programme have also located and collected plants from throughout Sierra Leone used for medicine.[12]
In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Sierra Leone is 970. This is compared with 1032.7 in 2008 and 1044.2 in 1990. The under 5 mortality rate, per 1,000 births is 198 and the neonatal mortality as a percentage of under 5's mortality is 25. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Sierra Leone the number of midwives per 1,000 live births is 1 and 1 in 21 shows us the lifetime risk of death for pregnant women. [13]
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