Rehabilitation centres for people with physical disabilities are facing closure or fees-for-service if the Ministry of Health and Sanitation doesn’t come through with promised funds.
National Rehabilitation Centres (NRCs) in Bo, Koidu Town and Freetown were established in the 1990s to cater for people with physical challenges caused by polio, stroke, partial paralysis or amputation, among other causes.
Services were free for more than a decade under funding from Handicap International (HI), said Sekou Keita, Rehabilitation Coordinator with Handicap International.
In March 2009, HI began a “handover” to the government. The MOU signed between the parties said HI would pay 100 per cent of costs in 2009, 50 per cent in 2010 and 25 per cent in 2011.
The Ministry of Health and Sanitation was to provide the remainder of necessary funds.
“The government must take up its full responsibility,” said Keita. “The ministry is not playing its role to cover costs.”
Abdul Kamara, acting manager at the Freetown NRC in Murray Town, said HI is giving 25 per cent support this year, which expires at the end of December.
He said the Ministry of Health and Sanitation hasn’t been paying their share. He added that the centre is looking for about Le375 million per year and currently receives about Le13 million from HI every three months, while the ministry of health and sanitation provides about the same, he said.
It means there is a signal that we are heading for trouble,” said Kamara.
“There are some materials you don’t find here and they are very much expensive; and the participation of the ministry in terms of up keeping this centre is very, very low.”
He said the contribution from the ministry couldn’t even run the centre for a month.
“It means maybe we desert the centre,” said Kamara. The acting manager said they were considering imposing user fees for services that are currently free to make up some of the budget shortfall.
Orthopedics Technology and Supervisor, Nathaniel S Kargbo, said many of the supplies used for prosthetic limbs and other devices come from abroad and are very expensive.
“Handicap International used to buy these materials and we do the assembly, we only fabricate the socket design and those components cost money and they cannot be found here,” he said.
Kargbo said they are almost out of supplies needed for their work and have no idea how they will get more.
“We need to find a method which people make like contributions for the appliances. We are now thinking of introducing a user fee,” said Kargbo. “The fees will be minimal.”
Under Sierra Leone’s Persons with Disabilities Act 2011, “every person with a disability shall be provided with free medical services in public health institutions,” and “Persons with disability shall be entitled to a barrier-free environment to enable them to have access to buildings, roads and other social amenities and assistive devices and other equipment to assist their mobility.”
Dr. Alhassan Seisay, the Deputy Chief Medical Officer for MOHS, said government is aware that HI support is winding down and they are trying to mobilize resources from other organisations like the EU. “Mobilizing resources is not a one day, one week event. It takes time,” said Seisay. “The policy of government is free service to the disabled.” He said as of now, the ministry has no plans to approve user fees at rehabilitation centres.
Keita at HI said in 2010 the budget was about US $124,500 to operate centres in Bo, Koidu and Freetown. The three centres served about 2,660 people.
He said HI will continue to give leadership advice, provide capacity building, materials and technical support to staff at the centre. Aminata Sesay, a patient undergoing therapy at the NRC in Freetown, said she doesn’t think she would be able to pay for treatment. She already struggles to pay transport to come from her home in eastern Freetown.
Staff said they often give patients money from their own pockets for transport. Fellow patient Mamadu Samura from Wilberforce said he’s suffering from a fracture and uses the facilities because it’s free.
“I will not be able to pay if the user fees are approved,” said Samura.