Before 2010 the health sector in Sierra Leone was faced with a lot of challenges including lack of adequate capacity of health workers, low motivation of the few adequately qualified that were in the system, lack of drugs and lack of appropriate medical equipment.
In 2011 however, the World Bank launched the Reproductive and Child Health Project with two components; with strengthening service delivery as the first component (Component One) attracting a whooping US$19.19 million. A sub-component of Component One is the Performance Based Financing (PBF) mechanism with a grant of US$ 5.7 million dished out based on satisfactory delivery of a set of five key interventions.
The fund focuses on six maternal and child health services including family planning, antenatal consultations, facility skilled deliveries, postnatal consultations, full vaccination of children under one and outpatients consultations for children under five.
The project is being implemented in about 1,200 Peripheral Health Units (PHUs) across the country where Basic Emergency Obstetrics and Neonatal Care (BEmONC) are performed.
It emphasizes on cross-cutting areas relating to staff welfare and management including attendance at work, timeliness of submission of HMIS Reports, functioning health management committee, display of management, no stock of out essential drugs, and appropriate medical waste management system.
The PBF according to Dr S.A.S. Kargbo has certain amount of money allocated to Community Health Centres based on the delivery and registration of patients, family planning and other health care services. 60% of the fund, he said is allocated to the staff and 40% to maintenance of the health Centre in collaboration with a Welfare Committee.
A team of World Bank officials including officials of the Ministries of Health and Finance were accompanied by a team of Journalists of the Development and Economics Journalists Association (DEJA) toured some ten PHUs in the Western Area and Southern, Eastern and Northern Regions to monitor understanding and compliance of the project especially the use of the PBF fund. The World Bank team included, Frances Ayodeji Akala Senior Health Specialist, Health and Population, Africa Region, Erica Monica Daniel, Noel Chisaka and Shunsuke Mabunchi
During the tours, the visitors observed a number of challenges with which medical personnel were grappling and they include lack of understanding of the process, lack of electricity, the untimely supply of essential drugs provided for the Free Health Care programme.
In the Western Area, the team visited Princess Christian Maternity Hospital (PCMH), and PHUs in Koribondo in Bo district, Daru and Levuma in Kenema, Yele in Tonkolili and Fadugu in Koinadugu district.
At the Koribondu Health Center the Community Health Officer (CHO), Vandy Kabba, revealed that there has been an increase in safe child deliveries and there was an increase in mothers and pregnant women visit to the center for medical treatment or care. Through the PBF, the Koribondo Community Health Centre has been equipped with Labour and Delivery Rooms with solar electricity and a generator to argument other areas.
Challenges still remain with the Koribondo Health Center. It lacks adequate running water. But the CHO informed that they are merely waiting to get resources from the PBF to maintenance the water system. It was strongly noted that the community partnership aspect of the implementation of the PBF in Koribondo is not been followed as stipulated.
Vandi Kabba went on to explain that his center is further challenged with the issue of referral, which he admitted has always been difficult when the need arises. He said because of this difficulty and the consequent delays in accessing an ambulance, many of their patients had lost their lives by the time the ambulance arrives or on their way to the main referral hospital.
The Yele Community Health Center is also faced with the challenge of electricity since they have to pay for it through a pre-paid meter system. The CHO, Peter Kommeh said paying for electricity is “very expensive.”
Because of the cost of electricity it was discovered by the team that the fridge hosting lots of the medicines including drugs for emergency use was switched off to conserve current.
At Fadugu, the CHO, Senessie Melvin Rogers, told the team that his unit covers about 48 villages and which makes his work tedious and challenging. He said they lack basic equipment like a standard delivery bed and fuel supply. These he noted, are preventing the center’s efficient and effective performance. He they are always in short of essential drugs meant for the FHC and that sometimes the center is supplied with items they had not requested for. “Most of the times, we are short of drugs and other medications for children,” CHO Rogers stated.
The CHO added that they also face accommodation challenge for the Midwife, noting that properly housing the midwife “is very crucial to maternal health care delivery.” However, through the PBF and consultation with the Facility Management Committee and staff work is on-going to construct a midwife quarter.
On the use of Traditional Birth Attendants (TBAs) at the center, the CHO said the TBAs promote health messages and help minimise maternal mortality.
The CHO further revealed that through the PBF they have been able to secure the services of three TBAs at the center and because of this complicated cases in child births and during pregnancies have reduced. He also said there is an increase in understanding on the use of the health center by pregnant woman.
Despite all the expressed challenges faced by the other centers, the Lavuma Community Health Centre proved to stand the test of time with its woman CHO, Hawa Margai in cheerful mood as she welcomed the visitors.
Her center was rated as meeting “compliance” by the visiting team since most of the cross-cutting issues she had overcome. Hawa enthusiastically led the team on a conducted tour and exposed them to the positive works she has done.
She proudly stated that since 2012 after the progamme was launched, her center has not reported any death and that with the funds from the PBF they have improved basic facilities also addressed basic staff welfare issues which include that of the TBAs.
By Betty Milton
Thursday June 12, 2014