By Kemo Cham
For someone who has been following keenly development in the health sector, I must acknowledge that there has been a lot of progress, especially since after the 2014 – 2016 Ebola outbreak.
A lot of money, mostly donor funds, has been poured into the health sector, both during the response to the epidemic and in its aftermath as part of the recovery efforts. And we have heard repeated blaring of political statements, which show that there is the commitment, even if just in words.
But there has always been the issue of sustainability of what little achievements we have made. A perfect illustration of this is with the much trumpeted Free Health Care initiative. The immediate aftermath of its introduction yielded positive results, but it didn’t go as far as it should. The numbers, in terms of infant and maternal deaths, are evident enough. How else can we explain them?
Like in almost every aspects of life in this country, duty bearers want to be told what they want to hear, rather than what they need to hear. We are witnessing a similar trend in the current government’s flagship ‘Free Quality Education’ progeamme. It’s the proverbial ‘see no evil, hear no evil, speak no evil’ principle for government officials.
When the people complained that the FHC wasn’t working, what those in charge were thinking wasn’t to fix the problem, but how what they took as criticism of their efforts would mean for the image of the government. Therefore efforts were spent on how to counter such criticism, rather than fixing the problems they exposed.
Consequently, women and children were and are still dying for unacceptable reasons.
As a health reporter, I have listened countless times to women narrate their concerns to the effect that the scheme is nonexistent. But personally I have also experienced it.
In a nutshell, the issue is not just about putting in place the infrastructure but also, very importantly, ensuring sustainability – sustainability both in terms of provision of resources and making health facilities as accommodating as possible.
If you have ever sought to use the Free Healthcare service, you must have experienced medicine shortage. If you are lucky you get paracetamol and some syrup that only appears to worsen your child’s condition. Even in the face of this difficult reality, patients are also having to deal with the unbecoming attitude of healthcare providers. Sometimes you wonder if some nurses really underwent any form of training. For most of them, it’s all about money, money, money. Woe betide you if you don’t meet their monetary demands.
During one of the struggles dealing with my asthmatic son’s condition, sometime earlier this year, I had a bitter encounter with a data entry clerk at the triage unit of the Ola During Children’s Hospital (ODCH).
We had spent the previous night at the Lumley Government Hospital where nurses couldn’t make any difference with his condition. He was crying hopelessly, for want of oxygen. And then there was power cut.
The CHO on duty eventually decided to refer us to ODCH.
All that data entry clerk could think about was what we had to give her as ‘Hajo’ (tip) for registering my son. I was so angry that I thought it was better not to respond to her. But she insisted, very shamelessly.
“Why can’t you do your job and stop asking me for money?” I said.
I have witnessed several times women handing out money to nurses in hospital. And because of this many have decided to stay at home and hope to God that their kids get healed by some miracle, because they do not have money to pay at the hospital.
During an earlier visit to the Lumley Government Hospital, there was no available bed in the children’s wing. The nurses who received us decided that given the emergency and severity of his condition, my son should be given a bed in the adult ward where there were available beds. But the nurses in charge of the adult wing didn’t like the idea, citing the danger of infection. While that made sense, it soon became clear that their concern was more than that. Since the boy was qualified for the FHC, they couldn’t make money from his stay there. They would rather have the space for an adult who would pay.
After back and forth among the nurses, they agreed for my son to take the bed, but on the condition that we would have to pay for all the medications. I agreed. I wasn’t expecting anything different. Even whereas the so-called FHC was available, I had always paid for the drugs anyway.
In the middle of that exchange, a family came in with their sick daughter. She was above five and therefore wasn’t qualified for the FHC. Apparently the family didn’t have money. The nurses wouldn’t touch her until they assure them that they had the money to begin the treatment. The family just left the hospital without notice.
Several studies have adequately documented this unfortunate aspect of Sierra Leone’s healthcare system, especially the FHC. Among the most recent is the Bio Meter by the Institute for Governance Reform (IGR), released in last April, which found that 18 percent of lactating mothers were still paying for healthcare.
Another report by the SABI consortium emphasized this issue. In its 2018 Citizens’ Perception Survey report, respondents were asked to rate the attitudes of staff of the health facility they visited. The highest scoring attitude was ‘kind’ and it attracted 40%, followed by ‘respectful’ with 23%, and then ‘supportive’ with 18%. In some sense this may sound good, but if, for instance, only 18% of patients find the staff of a health facility supportive, which is what you would expect from healthcare workers, what about the 82%?
And that Same report found that negative behaviours were selected by “a small minority” of respondents including ‘aggressive’ (6%), ‘intimidating’ (1%), and ‘rude’ (3%). Small minority, yes. But the survey, which covers just a small portion of the country, illustrate the existence of these problems that have the adverse effect of keeping citizens away from health facilities.
The latest report on bribery, as contained in the 2019 Global Corruption Barometer released in July, emphasized another frightening aspect of our society – corruption. It shows that bribery in public health centers increased by half in the last four years, from 25% in 2015 to 50% in 2019.
And these are by no means the first reports shedding light on this trend on healthcare services delivery in this country. Yet nothing seems to be happening in terms of response by the relevant authorities. It leaves one wondering: Do the statistics really matter?
Staff attitude is crucial to ensure sustainability. No matter how meagre the available resources are, with a dedicated staff we can maximize the impact of the services. And conversely, no matter how much resources we have, without the right attitude among caregivers, it will all be waste and will continue complaining endlessly.
Sierra Leone remains at the bottom of the Life Expectancy index: around 51 years for women and 49 years for men, according to the latest WHO statistics for 2016. Strikingly, we are below countries like Chad, CAR and Angola. Chad and Angola are understandable. But CAR? A country in conflict for God knows how long?
The good news is that the FHC could be very vital in changing this trend and enhance Sierra Leone’s effort to attaining universal healthcare. All we have to do is ensure we get the foundation level correct, wherein we don’t talk about medicine shortage or bed shortage.
This is not impossible, we only have to get our priorities right.
© 2019 Politico Online
