Promises and Pitfalls of the Free Health Care Initiative in Sierra Leone: An Early Analysis
- 230 Downloads
The purpose of this chapter is to examine one of the most significant pieces of legislature passed by the Sierra Leone state to address one cornponent of human security—access to health care for the most vulnerable of populations, women and children. Passed in 2010, the law provides free health care for pregnant women, lactating mothers, and children under five. In light of the appalling figures concerning maternal and child mortality in Sierra Leone, the policy is an admirable one, with enormous potential to improve on these rates and change the lives of women and children in Sierra Leone. However, given the weakness that continues to plague the state and the largely externally driven nature of the intervention, with donors providing the bulk of the funding, to what extent has this policy transformed the health landscape in Sierra Leone in addressing the problem of maternal and child mortality? Based on fieldwork conducted just three months after the policy was implemented in August 2010, we provide an early assessment of the free health care initiative (FHCI), looking at its impact on the lives of women and children and participant satisfaction with implemented activities, compare the assessment with current findings, and offer policy suggestions for improved implementation. While it would seem like the more favorable international climate afforded by the post-Washington Consensus has enabled Sierra Leone to spend more in public service delivery, the fact that much of this intervention is driven from the outside has had implications on the delivery of the service as well as how it has been received.
KeywordsHealth Care Facility Health Care Worker Maternal Mortality Human Security Oral Rehydration Salt
Unable to display preview. Download preview PDF.
- Amnesty International. “Maternal Mortality in Sierra Leone.” 2012. http://www.amnestyusa.org/our-work/campaigns/demand-dignity/maternal-health-is-ahuman-right/maternal-mortality-in-sierra-leone, accessed June 2, 2012.
- Awoko. “Free Health Faces Setbacks at PCMH.” Awoko, March 4, 2014. http://awoko.org/2014/03/04/sierra-leone-news-free-health-care-faces-setb ack-at-pcmh/, accessed March 4.
- BBC News. “Sierra Leone Starts Free Care for Mothers and Children.” BBC News, April 27, 2010. http://news.bbc.co.uk/2/hi/africa/8645968.stm, accessed July 12, 2012.
- Department for International Development (DFID). “Summary of DFID Work in Sierra Leone 2011–2015. Updated June 2012.” 2011. http://leonenet.info/documents/DFID_press_release_Sierra_Leone.pdf, accessed August 12, 2012.
- Department for International Development (DFID). “Sierra Leone. Operational Plan.” 2012a. Last modified June 2012. http://www.dfid.gov.uk/Documents/publications1/op/sierra-leone-2011.pdf
- Department for International Development (DFID). “Evaluation of DFID Support to Healthcare Workers Salaries in Sierra Leone.” September 2012b. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/206761/evaluation-support-healthcare-workers-salaries-Sierra-Leone.pdf, accessed March 5, 2014.
- Field Survey Data. “Pregnant and Lactating Mothers Access to Health Care Services,” by M’Cormack Fredanna, A. D. and Fredline A. O. M’Cormack-Hale. Sierra Leone, May–August, 2010.Google Scholar
- Global Pulse. “Free Health Care in Sierra Leone.” Global Pulse, June 17, 2011. http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/free-healthcare-sierra-leone, accessed August 12, 2012.
- Government of Sierra Leone. An Agenda for Change: Second Poverty Reduction Strategy (PRSP II)2008–2012. Freetown: Government of Sierra Leone, 2008.Google Scholar
- IRIN. “Sierra Leone: Health Fees Scrapped But Gaps Remain.” IRIN, July 18, 2012a. http://allafrica.com/stories/201207181188.html, accessed August 20, 2012.
- IRIN. “Sierra Leone: Drug Diversions Hamper Free Healthcare.” IRIN, July 18, 2012b. http://www.irinnews.org/Report/95896/SIERRA-LEONE-Drug-diversionshamper-free-healthcare, accessed August 20, 2012.
- Koroma, Ernest Bai. “The Free Health Care Initiative is Making a Difference in Sierra Leone.” Huffington Post, April 5, 2012. http://www.huffingtonpost.co.uk/ernest-bai-koroma/sierra-leone-fhci-the-free-health-care-init_b_1473835.html, accessed August 20, 2012.
- M’Cormack Fredanna, A. D., Fredline A. O. M’Cormack-Hale, and John F. Yannessa. “Lactating Women’s Perception the Free Health Care Initiative in Rural Sierra Leone.” World Medical and Health Policy 4 (2012): Article 5.Google Scholar
- Nossiter, Adam. “In Sierra Leone, New Hope for Children and Pregnant Women.” The New York Times, July 17, 2011.Google Scholar
- Samba, Augustine. “In Sierra Leone, Government Clarifies Health Budget Controversy.” December 21, 2011. http://news.sl/drwebsite/publish/article_200519421.shtml, accessed August 20, 2012.
- Statistics Sierra Leone. “Sierra Leone Demographic and Health Survey Report 2013.” 2013. http://dhsprogram.com/publications/publication-PR42-PreliminaryReports.cfm, accessed March 4, 2013. Republic of Sierra Leone.
- UNICEF. “At a Glance: Sierra Leone.” 2013. http://www.unicef.org/infobycountry/sierraleone_statistics.html, accessed March 5, 2014.
- World Bank. Maternal Mortality in 2005. Geneva, Switzerland: World Health Organization, 2007.Google Scholar
- World Health Organization. “World Health Statistics 2011.” 2011. http://www.who.int/whosis/whostat/2011/en/index.html, accessed June 12, 2012.
- World Health Organization. “Now It’s Free, How to Pay for It?” Sierra Leone’s Dilemma. 2010. http://www.who.int/bulletin/volumes/88/12/10–021210/en/index.html, accessed August 20, 2012. [Bulletin of the World Health Organization 2010; 88: 883–884. doi: 10.2471/BLT.10.02121]
- Wright, Simon, Luisa Hanna, and Mathilde Malfert. “A Wake-up Call: Lessons from Ebola for the World’s Health Systems.” Save the Children UK, 2015. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/WAKE%20UP%20CALL%20REPORT%20PDF.PDF, accessed March 2, 2015.