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Experiences of Free Health Care in Sierra Leone

Experiences of Free Health Care in Sierra Leone. Sierra Leone team presentation at the Improving Financial Access to Health Services Technical workshop - Dakar, Senegal, 2-4 November 2010 Presented by Michael m. Amara (Principal health economist). Health Sector Background.

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Experiences of Free Health Care in Sierra Leone

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  1. Experiences of Free Health Care in Sierra Leone Sierra Leone team presentation at the Improving Financial Access to Health Services Technical workshop - Dakar, Senegal, 2-4 November 2010 Presented by Michael m. Amara (Principal health economist) 1

  2. Health Sector Background • Health care delivered by: • Government • Local and international NGOs • Faith-based Organisations • Private sector • Government system is decentralized: • Peripheral Health Units (PHUs) • District Hospitals • Tertiary Hospitals 1

  3. Health Care Financing in Sierra Leone • Sources of financing (NHA 2007): • Government 19.2% • Donors 11.0% • Households 69.2% • For a poor country, out-of-pocket expenses are very high hence finance is a barrier to accessing health care. • In the SDPS 2008, 88% of households reported cost as the critical barrier 1

  4. Strategic Context and Rationale The problem: • High maternal mortality • High child mortality • Sierra Leone off-track to meeting MDGs • Poor health indicators • Restrictive out-of-pocket costs Rationale for Free Health Care (FHC): • to remove the most important barrier preventing mothers and children in Sierra Leone from accessing health care services. 1

  5. Main Pillars of FHC Target Groups: • Pregnant women • Lactating mothers • Children under-five Package of Services: all services delivered in government health facilities to target groups are free of charge • FHC is not a separate programme 1

  6. Funding sources for FHC (2010) • Government of Sierra Leone (GoSL) contributed 34% (US$36,842,112). Substantial increased on health workers’ salaries. • Health Development Partners (HDPs) contributed 66% (US$19,187,212) 1

  7. Policy Development and Implementation • National Steering Committee with 6 subcommittees formulated • Providers involvement and capacity building • Procurement of drugs and medical supplies • Substantial increase in health care workers’ salary • Information and communication to whole population • Using existing financing management system; implementing PBF 1

  8. Monitoring FHC • Existing HMIS monitors utilisation data • Civil society organisations accompany drug deliveries to facilities • CSOs also check whether targets groups are being charged • CSOs use MoHS-designed questionnaire and checklist to check facilities and patient satisfaction 1

  9. Strengths and Weaknesses • Strengths • Political commitment • FHC addresses priority health financing problems of large sections of SL population • Involvement of nearly all health stakeholders • Substantial salary rises implemented • Absorption of 1,000 qualified and practicing health professionals 1

  10. Strengths and Weaknesses • Weaknesses • No prior costing of FHC (including impact of likely utilisation increases) conducted before policy decision made and implemented • FHC not budgeted for (either by government or its donor partners) • Insufficient human resource base • Irregular supply of drugs and supplies • Lack of readily available data (HRH and drugs consumption per district) 1

  11. Challenges • Cleaning and updating health workers’ payroll still on going; • Sustaining the substantial salary rises to health workers; • Delay in the absorption of health workers onto the govt. payroll • Financing and supply of required drugs and supplies; • Involvement of the Faith Based Organisations (FBOs) 1

  12. Lessons learnt • Ownership and leadership by the MoHS • Joint planning and budgeting • Proper coordination with the establishment of committees and groups • Full participation of all health partners 1

  13. The Future • Developing a national IHP+ Compact • Developing PBF as part of the sustainability • SWAp 1

  14. Acknowledgements The Team • Dr Heidi Jalloh-Vos, Health Program Manager, Medical Research Centre • Michael Dauda, Senior Local Govt. Finance Officer, Ministry of Finance and Economic Development • Falla Ensa-N’Dayma, National President, Trade Union Confederation of Sierra Leone Others (for comments) • Dr Aminata Kanu, Country Lead Sierra Leone, MLI • Dr Natalie Quinn, Overseas Development Institute Fellow, MoHS • Dr Chris Atim, Senior Health Economist, The World Bank • Alllison Kelley, Country Lead Mali, MLI • Dr. Edward B. Magbity, Principal Monitoring and Evaluation Specialist. 1

  15. Thank you!! 1

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