By Kemo Cham
Out of every five children in Sierra Leone, one is likely to die before celebrating their fifth birthday, according to a UNICEF report.
This reality is at the center of the phenomenon known as infant mortality, one of the major health conundrums confronting Sierra Leone which is ranked among the top five countries globally with the highest rates of Infant Mortality at 114 deaths per every 1000 live births.
Infant mortality is actually just one side of a twin health problem for Sierra Leone; the other half is maternal mortality – that’s the number of women dying due to pregnancy related causes. Sierra Leone tops world ranking in this, with 1, 165 deaths per every 100, 000 live births.
Teenage pregnancy, Malnutrition, and Immunization have been identified as the three major factors fueling maternal and infant mortality in Sierra Leone. Experts say addressing these issues requires a responsive health system, which calls for a collaborative effort among healthcare providers and politicians. A coalition of NGOs and civil society organisations, headed by Save the Children International, last month initiated a campaign designed to mobilize political support in this regard.
Ahead of the March 7 general elections, political parties are putting together their manifestos. The healthcare campaigners want these health issues prominently captured in these development blueprints.
Political parties should not just draw programs that make people vote for them, but ones that will improve the lives of the people, especially women, said Zainab Moseray, Registrar of the Political Parties Registration Commission, at one of two consultative sessions held with political parties representatives. The first session brought together lawmakers and technical experts in the areas of concern.
All 14 political parties registered and certified by the National Electoral Commission at the time were invited to the second session which was hosted at the Family Kingdom Resort in Aberdeen, Freetown.
The campaigners say political will is crucial in ensuring a sound healthcare system not just to guarantee adequate funding, but also to formulate relevant policies and lead efforts of social mobilization.
“The idea is to challenge political leaders to come out and commit themselves to making difference in the lives of women and children,” said Mohamed Bailor Jalloh, Chief Executive Officer Focus 1000, a leading local partner in the initiative.
Teenage pregnancy is rife in Sierra Leone, fueled by numerous cultural and traditional factors, including poverty and early marriage which is driven by religious considerations. In some communities girls as young as 12, are forced into marriage. At such age, say reproductive health experts, their bodies are highly susceptible to a lot of life threatening post-partum complications.
According to the last Demographic and Health Survey (DHS), 46 percent of all adolescent deaths in Sierra Leone were linked to maternal deaths.
Babies born to teen mothers also tend to have low birth weight and are predisposed to a variety of illnesses.
According to the National Nutrition Survey of 2014, one in 3 under-five children in Sierra Leone is malnourished. This translates to nearly half a million children. Experts say malnutrition exposes both mothers and their babies to a horde of diseases which, if not handled in time, can lead to untimely death.
The NGOs behind this initiative are all members of the SUN [Scalling Up Nutrition] Movement, a global campaigned against malnutrition. In Sierra Leone, the Secretariat of the Movement is hosted in the Office of the country’s Vice President. Nutrition expert Dr Mohamed Foh coordinates the Secretariat. He said hosting of the Secretariat at this level is enough demonstration of political will on the part of government, stressing the need for further collaboration with the private sector.
Dr Foh said to reduce either child or maternal mortality requires investment in nutrition, noting that with adequate nutrition, immunity against diseases is boosted.
“A child who is stunted is a child with cognitive challenges and can hardly attain their full potential,” he said.
He added: “A public private partnership is also required because we need research, we need to produce our own, we need to feed our own people. And we need to encourage the businesses.”
Nearly half of Sierra Leone’s population - 3.5 million people - faces hunger, according to the Global Hunger Index. To overturn this situation requires policies that increase allocations to relevant ministries geared towards increasing annual food production.
Malaria, pneumonia and diarrhea have been identified among the three main killer diseases of children in Sierra Leone. Experts say these are less likely to kill if a child is well nourished and most likely to kill if under nourished.
Exclusive breastfeeding is one way of addressing the issue of malnutrition in children and which require public private partnership. For instance, efforts are already underway through the SUN Movement to halt the proliferation of breast milk substitutes which campaigners say have encouraged many mothers not to breastfeed their babies.
According to the DHS only 59 percent of mothers exclusively breastfed their babies. It requires lawmakers to legislate against indiscriminate importation of these milk substitutes to address this situation.
Campaigners also want authorities to provide specific nutrition budget lines for nutrition and nutrition related programs.
“For this to happen, we must have fully functional government structures and specific interventions such as planning and budgetary training,” said Dr Foh.
Fortunately, most of the common killer-diseases of children in Sierra Leone have preventable vaccines which are listed by the Ministry of Health’s Expanded Program on Immunisation (EPI).
The EPI lists about a dozen vaccines administered on mothers and babies, from pregnancy up to 15 months of the baby’s life.
Dr Dennis Marke, Program Manager of the EPI, said the ministry’s strategy mirrors the global vaccine action plan, which is to reach every child with every needed vaccine. Dr Marke cited about half a dozen new vaccines earmarked for inclusion into the national vaccine delivery system in 2018 and 2019.
“But this is going to raise counterpart payment and this is where political support is needed,” he said.
Sierra Leone pays millions of US Dollars in counterpart funding for these vaccines which are often procured through the Global Vaccine Alliance, funded mainly by the Gates Foundation.
To meet this counterpart funding commitment will require a substantial increment in budgetary allocation to the health docket.
The civil society have for a long time been seeking to get politicians treat health as a human rights issue. The latest attempt was made at the just concluded review of the 1991 Constitution, where a submission was made for the donor-funded partial Free Health Care program to be made a constitutional right. The Government, however, rejected the proposal.
Sierra Leone has failed repeatedly to meet the African Union’s Abuja Declaration on budgetary allocation on health. The agreement, which was passed at a heads of state summit in the Nigerian capital, Abuja, requires member countries to allocate at least 15 percent of their national budget to the health sector.
Within the last 10 years, Sierra Leone’s allocation to the health sector has fluctuated between 9 percent and 11 percent, amidst inconsistently unreliable disbursements.
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