By Kemo Cham
The image of this young girl in visible pains, whose mother was forced to return her home untreated for lack of money to pay for her treatment, still haunts me.
I was struggling to get treatment for my son who had got an asthma attack. Because he was under-five, my son was qualified for the government’s so-called Free Health Care (FHC) scheme. But the beds in the children’s ward at the Lumley Government Hospital were fully occupied. And because of the emergency nature of his sickness, some of the nurses advised against referring my son, which would have meant traveling through the chaotic traffic from Lumley to Cottage Hospital through the highly congested Fourah Bay Road traffic.
“There is no fuel in the ambulance,” the Community Health Officer in charge said.
We negotiated and the nurses agreed to allocate us a bed in the adult ward, provided that we paid. After all, even in the children’s ward I had always paid – so much for the FHC.
In the middle of our situation, I couldn’t help but noticed the plight of this family - a single mother accompanied by a male relative – who had arrived with their sick daughter. The nurses wouldn’t touch her until they make an initial payment for some medication they said wasn’t available in the hospital’s pharmacy.
No one must have noticed when they “sneaked” out of the hospital, apparently ashamed to say they didn’t have the money.
In spite of my own personal experiences, that incident early in the year serves as a constant reminder to me of the challenge Sierra Leone faces to meet one of the world’s most important goals in global health – Universal Health Coverage (UHC).
I have seen and heard of countless cases of patients staying away from health facilities because of lack of finance. This is exactly what the UHC speaks to.
One of the United Nations Sustainable Development Goals (SDGs) adopted in 2015 by member UN countries, the goal of the UHC is that everyone receives health services they need without having to suffer undue financial hardship or regardless of whether or not they have the finance.
Last September, world leaders again signed the UN declaration on the UHC to strengthen both primary health care and the health workforce, a crucial requirement to attaining this global commitment.
UN Secretary-General, António Guterres, in his message on the 2019 commemoration of the UHC last week [December 12], said the endorsement by world leaders of that “ambitious political declaration” reaffirmed that health was a human right.
“The agreement is a significant achievement that will drive progress over the next decade on the 2030 Agenda for Sustainable Development,” he said, calling on the leaders to “keep the promise and ensure health for all is a reality for everyone, everywhere.”
Government priority
You don’t have to get close to health facilities to see that this is a near impossibility for Sierra Leone under current circumstances. The work of the Sick Pikin Campaign provides a perfect illustration. As I writer, activist Ishmail Charles and team are preparing for the second edition of the annual marathon of the organization as a way of raising funds to facilitate treatment of children with deforming and life threatening diseases the government doesn’t prioritize.
The marathon, while it raises some much needed cash, has become more about awareness raising than fund raising, because the money gotten from it is like a drop in the ocean for the cost involved in treating the diseases and the overwhelmingly high number of requests the organization receives, according to Mr Charles.
What the Sick Pikin Campaign has exposed is not just how poverty is depriving many Sierra Leoneans from accessing lifesaving healthcare services, but also how unprepared the country’s healthcare system is to take care of the health needs of its people.
Moving towards universal health coverage requires sound policies based on data and analysis. But more importantly, countries must invest in the health sector.
Unfortunately, developing world government’s like ours don’t seem to prioritize health care as much as they do sectors like infrastructure. Infrastructure is good, no doubt, but it’s meaningless for a country where the people are exposed to all sorts of diseases with an almost nonfunctional healthcare system.
Consequently, we are still struggling with high rates of maternal and infant mortality. Sierra Leone ranks in the bottom five list of countries with the lowest life expectancies in the world, with 55 percent life expectancy in 2017, the latest figures from WHO.
“We believe that health care is a human right for all people, not a privilege for those who can afford it. If that’s the case, we can’t accept a world in which people are impoverished by exercising that right. That’s why we are both committed to universal health coverage, so that all people can access the health services they need without financial hardship,” wrote Japanese Prime Minister Shinzo Abe and WHO Director General Tedros Adhanom Ghebreyesus, in a joint piece published on the Washington Post to mark the 2019 UHC.
The choice of Abe as co-author for Dr Ghebreyesus was no coincidence. Japan has a remarkable story of a journey to be one of the leaders in healthcare provision in the world.
According to the article, Japan, one of the most affected by the Second World War, began rebuilding with a focus on healthcare. It invested heavily on the health of its population through the provision of a health insurance scheme that covered everyone. Today, Japan has the world’s longest life expectancy and the world’s third-largest economy. In 2021, the East Asian island nation will celebrate the 60th anniversary of its universal health insurance scheme.
Inspiration
Japan can serve as an inspiration for countries like Sierra Leone.
We can, for instance, start by reviewing our comatose FHC.
Besides shortage of beds, Sierra Leone is still struggling to provide adequate basic drugs. The FHC, which has the potential to be a game changer for the country, is still powered over 80 percent by foreign aid. Even at that, there are reports of constant shortage of drugs.
There is no gain mentioning the huge deficit in human resource, especially specialist medical practitioners.
Amidst this state of affairs, a huge segment of the health sector have been neglected, like mental health and diseases like the ones the Sick Pikin Campaign provides support for.
No matter how much resources in terms of equipment is poured into the sector, Sierra Leone must also work on less discussed issues – like the attitude of healthcare providers. Besides the unprofessional conducts of many, there are reports of misdiagnosis and wrong prescriptions, just to name a few.
About two weeks ago, a video of a young pregnant woman struggling to her death in a government hospital in Pujehun is still fresh in the minds of the public. On the surface, that incident pointed to a perennial problem of unprofessionalism. But underneath, there are also the issues of man power and skills shortage.
We haven’t been able to fulfil our commitments to vulnerable communities like the disabled and survivors of the 2014-2016 Ebola Virus Disease outbreak.
There is a lot of work to be done on health security. The recent Lassa Fever outbreak is a sad reminder of this. Before that an outbreak of a mysterious killer disease among pigs struck and left dozens of poor farmers helpless after losing their herds just overnight. Sadly, about three months on after that incident, the public is yet to know what the cause of the death of the animals was. That is a pointer to the unforgivable weakness in the country’s health security agenda.
If Sierra Leone is to make any headway in terms of meeting the universal health coverage goal, these issues require serious thinking in 2020, just a year before the end of the lifespan of its national health sector strategic plan which envisions the realization of all these and many more.
Copyright © 2019 Politico Online
