It is indeed a fact that due to the terrible terrains we have out here, the poor road networks, the remoteness of so many communities especially those on the boundaries with Guinea and Liberia, no incentives for the countryside, very few trained midwives, sparsely located Peripheral Health Units, people’s lukewarm attitude and deep rooted traditions as regards health issues and child birth, we can hardly cover the entire country when it comes to health service delivery. Even with the free health care scheme which is doing remarkably well so much resources have to be committed in order to reach every nook and cranny. Sierra Leone is a small country but it appears also big because of inadequate resources that make contacts difficult.
When last week I read in one of our newspapers that plans were afoot to do away with Traditional Birth Attendants (TBAs), I felt very uncomfortable. We all know that over the years TBAs have had all the necessary training it takes to make their work very hygienic and semi professional in their own right. In a country where health facilities are just too inadequate, semis volunteer corps like the TBAs needs to be encouraged to continue their support. In any case whether we like it or not a lot of deliveries in remote rural areas are supported by TBAs simply because there are no trained medical personnel available in those far away god- forsaken plashes that hardly seem part of our country. It is the case wherein a vehicle accident, a man’s foot is badly cut and stuck under a very heavy iron. You need to cut the leg there and then if you have to save the man’s life. With the enormity of the weight of the Millennium Development Goals (MDGs) to be addressed, it could definitely be foolhardy to leave the TBAs out of the health delivery equation.
The UN Millennium Development Goals Report of 2008 states: The high risk of dying in pregnancy and child birth continues unabated in Sub-Saharan Africa and Southern Asia. Even in this current year 2011 one out of every three women each year give birth without a midwife. Do you see the seriousness of the problem here? We might provide the medication for the pregnant and the new born, but if there are not midwives or TBAs the problem remains. If the Millennium Development Goals 4, 5 and 6 are to be met, we need to have more midwives. While this is arranged, it will be necessary to make the best use of TBAs.The Recent talk of the formation of a Health Service Commission is very welcome news. This body, if it functions well, will support the Free Health care strides in a very big way.
One proactive activity that the Anti-Corruption Commission has over the years been doing is Systems reviews. Whether that report has been followed up is yet to be seen. But I think it is a very good review. The review is Titled: towards a better Health Care Delivery System. It is interesting to look at the Ministry of health and Sanitation’s Mission Statement. It goes: To ensure that available resources (human, financial and material) are maximally utilized for the purpose of achieving the Goal of the Ministry, which is to provide quality, affordable and accessible health care services to the people of Sierra Leone. I am pretty sure for nor are the TBAs part of the available resources mentioned in the Mission. The ACC review is partly informed by some public perception surveys earlier conducted on the Ministry. In 2006 a Service delivery Perception survey conducted by the Center for Economic and Social Policy Analysis. This survey indicates that half of the population of Sierra Leone attends a health facility once every year. According to the ACC report says that this poses a serious challenge to affordability and accessibility. Only the Western Area is said to meet WHO staffing ratios of one doctor per 12,000 population. Kailahun has one per about 200,000. This kind of situation makes it most necessary to improve the knowledge base of the TBAs who are on the ground everywhere there are no medical personnel. The gains scored since 2006 are indeed significant but still we have a long way to go. The ACC’s findings paint in part nothing short of a rather grim picture of the real situation. For example the report says that that accessing budget allocations has to0 a large extent proven cumbersome.. Sometimes the funds are not just available. Another finding is that it seems Medical Staff levy charges indiscriminately for their services even though they use government facilities and medical equipment. Other key issues are maintenance of Ambulances; too much private practice; misappropriation of drugs, drugs expiring; unsatisfactory laboratory services, among others.
Among the recommendations made by the ACC are the improvement of the conditions of service of medical personel; sufficient allowances for health care providers deployed in remote areas; tracking of drugs purchase; Financial information to be made known to Vote Controllers at all times.; Increase government subvention to hospitals; policy on oversees treatment to be made transparent.; decentralization of secondary health care Services, among others.
It is quite clear that to implement the ACC’s recommendations needs a lot of resources and time. In the instance where funds are difficult to come by, it will be difficult to carry them through. This is where when international targets like the MDGs are set one doubts if the Developing World which really experiences the deprivations captured in the document, are considered. Out here as many as 60% of women in most developing countries still do not have access to skilled care during child birth.
We must however recognize the tremendous work done by the Ministry of Health and Sanitation, UNICEF and the various partners who are trying hard to meet the MDGs. While gains are scored here and there, it is worth noting that the role of the TBAs has to be acknowledged .Give them further training and equip them…they are on the ground all over the place. A razor might be sharper than knife but definitely does not chop wood The TBAs should be in the complimentarity chain, at least for now, since very few midwives are available in the remote areas. If you scrap the TBAs now, it will be like cutting the nose to spite the face. And remember you cannot use a bucket of water to put out a forest fire.
One angle that I consider necessary to back up the health issues is water, sanitation and hygiene aspects. Most of the diseases gotten in the remote rural areas are water borne and of course we are yet to have clean drinking water in many parts of the country. This remains a big challenge and could actually threaten the successes scored in the Free Health Care Scheme. Watch this and so much more can be achieved. In all this there should be participatory decision making at the communities governance levels, so that the common good may be considered. Definitely we cannot solve problems by using the same kind of thinking we used when we created them. Let us try hard to act outside the box. In this whole scenario, we see a direct link between, education, health, environment, and food security.
By S. Beny Sam