By Kemo Cham
Amidst the euphoria surrounding last Friday’s announcement of Sierra Leone’s stellar performance in the 2020 Millennium Challenge Corporation (MCC) scorecard, we must save some time to think about lingering issues, notably the country’s poor performance in certain other indicators.
Of greater concern should be the country’s consistently poor performance in the health related indicators - Health Expenditures, Child Health and Immunization. According to the scorecard, Sierra Leone passed only the Health Expenditures indicator, which is good, only that it raised some questions needing urgent answers.
The MCC, a US government foreign aid agency launched in 2004, provides support for developing countries as reward for meeting key indicators that are geared towards democratic and good governance.
Countries eligible for the support, called candidate countries, are scored every year based on a total of 20 policy indicators used to determine eligibility for assistance programs. These indicators include access to education, control of the economy, access to credit, spending in the health sector, and the fight against corruption. All of these are grouped under three broad categories: Ruling Justly, Economic Freedom and Investing in People.
The three health indicators fall under the Investing in People category.
Sierra Leone passed 11 out of the 20 total indicators.
For a candidate country to be considered as having passed the scorecard, they must pass half of the total indicators, including the fight against corruption and democratic freedom.
After 12 years of trial, Sierra Leone finally passed the scorecard, meaning it passed all three hurdles, with its biggest score in Freedom of Information and Business Start-up, with 85 percent each. The performance on Freedom of Information is a shocker, but that’s a topic for another day.
My interest presently is on the health indicators.
With 68 percent, Sierra Leone’s performance on Health Expenditures makes it its 5th best performance, behind the fight against corruption with 79 percent and Trade Policy with 70 percent.
Interestingly, much of the celebration focused on the country’s success in the fight against corruption indicator. And this is understandable, given the leap from 71 percent in the 2019 scorecard to 79 in the 2020 scorecard, and also the significance of this in passing the scorecard.
What doesn’t make sense, however, is how this performance in Health Expenditure could not be translated to a better outcome in the related health indicators.
A closer look at the scorecard reveals that the health expenditure indicator has a direct impact on the other two health related indicators, as a candidate country tends to realize gains in them when the expenditure increases.
Since 2007, when Sierra Leone first became a candidate country, it has never passed the child health indicator, which measures a government’s commitment to child health as measured by child mortality, the sound management of water resources and water systems, and proper sewage disposal and sanitary control. The country has passed the immunization indicator only four times, while it has passed the health expenditure five times.
The question therefore is: if we did so well in expenditures, how comes this doesn’t show in our performance? Did the resources provided go to the right target? Are the government’s priorities in tune with the actual needs on the ground?
Sierra Leone is among the top 10 countries in the world with the highest infant mortality rate at 114/1000 live births. A 2016 Unicef study showed that one in five children in the country is likely not to celebrate their five years birthday.
Sierra Leone also has the highest Maternal Mortality ratio in the world at 1, 165/100, 000 live births. Maternal Mortality is closely linked to infant mortality.
According to the Sierra Leone National Reproductive, Maternal, Newborn, Child and Adolescent Health Strategy 2017-2021, the major causes of under-five deaths in the country include: Neonatal (29%), Malaria (20%), Pneumonia (12%), Diarrhoea (10%), injuries (5%) and others at (24%). Leading causes of neonatal deaths are identified as: Preterm (30%), Asphyxia (27%), Sepsis (23%), Pneumonia (7%), Congenital (7%) and others (7%).
While some of these, like Pneumonia and Diarrhoea can be prevented via vaccine (immunization), for the rest, all that is needed is ensuring a properly functioning healthcare system that responds to the needs of citizens. For this to happen, all the government has to do is to move beyond rhetoric to real action.
The MCC 2020 scorecard is therefore another reminder for the need for the government to review its approach to the healthcare system, particularly child health.
Healthcare spending generally has been a major concern for Sierra Leone, in the sense that the country is still spending far below the African Union recommended 15 percent GDP. In the last five years, the national budgetary allocation has hovered around 9 and 10 percent. The government must endeavor to meet this target.
The introduction of the partial Free Health Care (FHC) program in 2010 may have occasioned a lot of improvement in the health of mothers and babies, but it certainly hasn’t attained its goal, as illustrated by these statistics.
Having said that, the FHC is a clear illustration that bold moves like it can deliver results.
The country’s performance on the fight against corruption indicator is also another pointer to this potential.
If the same vigor expended on the fight against corruption is directed to the healthcare sector, we will in no time see the much needed improvement in it.
© 2019 Politico Online
