On 27 April 2010, Sierra Leone’s Independence Day, health user fees were abolished for pregnant women, new mothers and children under 5 years old throughout the country. Sierra Leone has one of the highest rates of death among pregnant women and new mothers in the world, so this was a crucial step.
Health Poverty Action has been working to improve maternal and child health in Bombali district in the north of Sierra Leone since 2005. Cost is a major barrier to health for the poor and marginalised communities with whom we work so removing fees for at least some of them is extremely welcome.
However we also warned that there needed to be a lot of support to make sure the removal of fees did not have unintended negative consequences. In particular, longer-term solutions must be found to finance health systems – including funding for more health workers, essential equipment and supplies. We have been working with the Ministry of Health since April and carrying out surveys of local health centres to report back on the user fees removal in Bombali and how it is going.
So far, on the positive side, many more pregnant women, new mothers and their young children are now coming to the health centres. This is the central outcome that was hoped for, as the cost barrier has been removed. It is a real breakthrough in providing poor women and children with access to health services, which is vital in reducing their levels of death, complications and serious illness.
Most of the centres have received all or nearly all of the essential drugs they require, although stocks are limited. There was a real concern that drugs would run out as more people came to the health centres, so this is good news. However, many of the health centres have not received supplies of certain essential drugs that help with emergencies in labour and child birth.
There is also a lack of basic materials such as gloves, needles, syringes, as well as equipment such as beds, mattresses, and linen. Buildings are often in a poor state of repair, and there are infestations of bats in some health centres, resulting in a poor level of hygiene. The poor road network and distance to the health centre from many villages continue to present a barrier to all women being able to access quality care in a timely manner.
The lack of trained health workers in Sierra Leone remains a long-term constraint. Despite the higher numbers of patients, staff numbers have not increased so the training and recruitment of many more doctors, nurses and midwives will be crucial to addressing this gap.
The removal of user fees is vital and we urge other developing countries to do the same, so that cost no longer creates a barrier to essential health services for poor communities around the world. However, Sierra Leone must be given aid and advice to train more health workers, provide supplies and infrastructure, and find new ways of funding its health system in the long-term, so the country can fully meet the health needs of its citizens.
You can download our March 2010 report on the removal of user fees in Sierra Leone here:
Abolishing user fees in Sierra Leone (942.28 kB)
Last modified: 07/01/2011
