By Amin Kef Sesay
A report monitored on the Sierra Leone Broadcasting Corporation Radio this week describing the appalling physical dilapidation of a primary health care unit facility in a chiefdom in Koinadugu district that included gross staff shortage, and workers volunteering without salary showed clearly the urgent need for the Ministry of Health and its development partners to prioritize the development and equipping of PHUs as a critical first step towards ensuring the health of particularly the 80 percent of Sierra Leoneans that live in the urban communities.
The 2014-2015 Ebola Virus Disease (“Ebola”) outbreak in Sierra Leone has highlighted the need for high-quality health promotion and adequate investment in this critical area.
The then Chief Medical Officer in the Ministry of Health and Sanitation, Dr. Brima Kargbo, at the time noted that, “We acknowledge the significant role health promotion played in finally containing the outbreak, particularly through social mobilization and mass media communication strategies.
“Strategic health promotion interventions continue to promote optimal health behaviours including creating demand and increasing health service uptake. The human resource challenges that the health system faces (in terms of staff numbers and skills) extended to health promotion cadres.
“As a result, we face challenges of adequately addressing the health needs of the population. This Strategy consists of national health priorities that all partners must rally around, including a plan for improved human resources for health promotion, capacity strengthening, advocacy and strengthened monitoring and evaluation systems.
“The work plan that accompanies this Strategy provides a solid roadmap, in the medium term, to improved health promotion that benefits the people of Sierra Leone…”
According to official source, in Sierra Leone, the burden of disease is predominantly communicable disease, with 25% of deaths due to malaria, 9% due to hypertension and 9% due to maternal causes. In outpatients, the predominant conditions are tuberculosis, human immunodeficiency virus, hepatitis, hypertension and diabetes.
Ebola exacerbated an already challenging situation in terms of human resources. There were 1.4 doctors, nurses and midwives per 10 000 population compared to the most recent sustainable development goals threshold (set in 2016) of 44.5.
In absolute terms, this equated to a qualified workforce of just over 1000 doctors, nurses and midwives, with an approximate shortage of 32 000. There was only one medical school in the country from which approximately 30 graduates pass out per year.
Within Sierra Leone, there is also an urban–rural split, with many doctors preferring to live and work in the urban areas.
Each district has a health management team and an average of 50 peripheral health units (PHU) and over 100 technical staff. The management team is responsible for planning, organizing and monitoring health provision, training personnel, working with communities and supplying equipment and drugs.
Critically, it is the PHUs that are designed to be the delivery point for primary health care in the country and there are three main types.
The community health centre carries out health prevention measures, cures and health promotion activities and is in charge of overseeing the other PHUs in the area. It is planned that in each chiefdom, the unit of local Government in Sierra Leone below the level of district should have at least one community health centre.
Community health posts perform a similar function to community health centres but have fewer facilities and are used to refer patients to the health centre or the district hospital.
Maternal and Child Health posts are the first level of contact on the ground and are located in smaller towns with populations between 500-2000. Much of the health care infrastructure was decimated during the Civil War. Long after the war, and after Ebola, the health service is still in the process of being organized with hospitals and PHU being rebuilt or created and staff being trained.
