By Kemo Cham
Sierra Leone must shed its love for donor support and consider putting its own resources in its health sector if there can be any headway in the provision of quality and affordable healthcare services to the people, a leading healthcare campaigner has said.
Victor Lansana Koroma, the head of the health campaign group Health Alert, said government must move away from the entrenched idea within the Ministry of Health that running the health sector through donor funding will solve its problems. He was speaking in the context of the 2020 national budget which was presented to parliament two weeks ago.
The 2020 Appropriation Bill (budget) was presented to the House by Finance Minister Jacob Jusu Saffa on Friday November 8.
It allocated 11 percent to the health docket. And the activist said that was far below expectation, blaming it on the entrenched idea within the MoSH that donors will always be at hand to fill the gap.
“There is already a donor fatigue,” Koroma told Politico.
“We should be able to raise our own resources and use them judiciously to improve the quality of lives of our people,” he added.
Health Alert is a network of civil society and human rights advocacy group established in 2009 to advocate, educate and inform the people on health issues and health care service delivery in Sierra Leone. It also seeks to promote the interest and rights of vulnerable and marginalized categories of people especially women and children in various communities to access quality and affordable health care services and ensure their human rights are respected and protected.
A key component of the group’s activities include advocating for a reasonable health budget.
While the 11 percent allocation marks an increase of about 1 percent from the 2019 allocation, it still falls far short of the African Union’s Abuja Declaration on local health funding.
The government had repeatedly said it intended to invest hugely in the health sector, in line with its human capital development agenda. Specifically, it plans to hire 3, 000 health sector workers in the coming year.
Koroma said if all of these can be attained and the impact is felt by the people, the country must be striving to meet the Abuja Declaration target which requires African Union member countries to spend at least 15 percent of their GDP on the sector.
Despite repeated promises, Sierra Leone has constantly failed to meet this target, revolving between 9 and 11 percent over the last 10 years.
Koroma said with Sierra Leone’s neighbor Liberia allocating up to 14 percent to its health sector, there was no excuse for the home country to maintain this trend.
The current government prioritizes education and infrastructural development, which attract the largest chunk of the budget.
The activist said while education and infrastructure were important for development, without a healthy population none of them could be possible.
“Health is critical to development,” he said on a telephone interview from Nairobi in Kenya, where he was attending the just concluded International Conference on Population and Development.
He said Sierra Leone was under obligation to meet its international and local commitments, which was important to maintain a trusting relation with its development partners.
Koroma said the MoHS most desist from leaning on donor support and increase local funding of its activities. He believed officials in charge of the ministry have grown accustomed to the idea that international support comes in regularly and so they lay less premium on attracting more government funding.
The activist is also concerned about the impact of low and irregular disbursement of funds allocated. He said a budget tracking process done by a consortium of civil society organizations, which Health Alert is a part of, revealed that disbursement rarely exceeds 6 percent.
He added that there was also a need to look at accountability in terms of how much of these disbursed monies go to priority areas, which he calls real disbursement.
“A whole lot of the expenditure is not service delivery, it’s about travel, training and salaries. Probably less than 3 percent of the disbursed funds goes to service delivery,” he said.
Le1.9 trillion needed for health workforce policy
Sierra Leone will need Le1.9 trillion investment in the health sector to rollout the National Human Resource Workforce Policy, a study has revealed.
The study done by the Human Resources for Health Policies and Standards Unit in the Ministry of Health and Sanitation (MoHS) also found that the country will require Le6.4 trillion for job creation in the sector in the next decade.
The outcome of this study was presented over the weekend by Dr. Giorgio Cometto, the head of the Human Resources for Health Policies and Standards Unit, at a validation session of the document which is part of an ongoing review of the health workforce labour market.
Two separate validation exercises were convened in Freetown and in Bo in the south of the country.
Participants were drawn among key stakeholders from both public and private sectors to validate the document that was put together by a joint team of local and international Experts. Officials say the goal of the review is to ensure quality health service delivery.
The World Health Organization Country office’s annual report for 2017 showed that the total health workforce in 2016 was 19 030, for a population of 7million people. Nearly half of that – 9120 (48 percent) was unsalaried.
That WHO report concluded that Sierra Leone experiences shortages of skilled healthcare providers - doctors, nurses and midwives - with the most critical staffing shortages found to be in the mid and higher-level clinical tiers.
And 70 percent of the workforce was said to be based in the urban centers which accounted for just 38 percent of the population.
Data from the 2016 Human Resources for Health Country Profile by the MoHS showed that nearly three quarters of the total health workforce is distributed across 10% of the country’s health facilities.
Consequently, an overwhelming majority of Sierra Leoneans have to go through constant struggle to access a service provided by a skill healthcare worker.
“As a means to make the health workforce market attractive and rewarding, several interventions have been mapped out by key players in the health sector to produce a sustainable solution to all the challenges, but the recent validation is key to boosting the sector,” a news dispatch from the office of the Public Relations of the MoHS, which was shared with journalists, reads in part.
It cited Dr Cometto elaborating on the need for various policy options that requires strong and committed political will and governance structure. These include a health workers policy, a focus on retention and utilization, review of staffing norm, the conduct of annual facility to facility health workforce gap analysis, and ensure improvement of the capacity and competence of the health workforce. Dr Cometto also noted the need for an equitable distribution of the health labour force with consideration of hard-to-reach areas with standardized remuneration.
The presentations were followed by open discussions in which recommendations came from participants geared towards health sector strengthening and capacity development. They specifically speak to issues that seek to increase production and occupational output among midwives, doctors, biomedical technicians and nurses.
The need for a comprehensive national labour market information system under the Ministry of Labour and Social security was also recommended with a prospect of upgrading the capacities of State Enrolled Nurses and Maternal Community Health (MCH) aides.
It was unanimously agreed that the MCH aide cadre be also improved on and retained, given the pivotal role they play in remote and difficult terrains across the country.
The ministry of health said the main thrust of this intervention is part of efforts to place Sierra Leone on the path to attaining global health security and achieve universal health coverage by the year 2030.
Copyright © 2019 Politico Online
