By Kemo Cham
There has been a drastic reduction in hospital attendance in Sierra Leone’s eastern Kailahun District due to fear of Covid-19, a new report has revealed this week.
The report, the result of a study conducted by the campaign group Network Movement for Democracy and Human Rights (NMDHR), focuses specifically on the services provided by Peripheral Health Units (PHUs) and the principal beneficiaries of the government’s Free Health Care Initiative (FHCI): pregnant women, lactating mothers and children under five. It revealed a 70% decrease in attendance by these people.
The study also points to reduction in community outreach, which affects immunization and health education.
Data in the study was collected by NMDHR paralegals from across 17 PHUs in the chiefdom, specifically looking at general PHU attendance; antenatal and postnatal care visit; maternity and under 5 deaths. The study also looked at levels of deliveries at the PHUs, health education outreach, availability of the FHCI drugs, as well as motivation for health workers.
The report, titled: ‘The Impact of Covid-19 on the Primary Healthcare Delivery,’ was published on June 2, covering the period April 1 to May 30.
The findings show that since April, deliveries at PHUs saw a 60% decline, suggesting that pregnant women are now relying on Traditional Birth Attendants (TBAs) for home deliveries, the authors wrote.
NMDHR, which is headquartered in Freetown, works mostly at community level with the broad mission of promoting human rights and governance issues through training, dialogue, advocacy, lobby and campaigns. The organization says it seeks to change the mindset of the people and increase their participation in governance so that development and peace can take place.
Since the outbreak of Covid-19 in the country, NMDHR, using health justice and rights based approach, has been working with local authorities, including the local council, the District Health Management Team (DHMT), Village Development Committees and partners to support awareness campaigns for prevention and mitigation of the viral disease, with particular focus on Luawa Chiefdom, the focus of the study.
PHUs are the frontline health service mechanism in rural communities in Sierra Leone. They are staffed with Maternal and Child Health (MCH) aides, Community Health Officers (CHOs) and supported by community health workers, including Traditional Birth Attendants (TBAs) and volunteers. These are trained to provide antenatal care, supervised delivery, postnatal care, family planning, child growth monitoring, immunization, health education, management of minor ailments, and referral of cases to the higher levels.
The involvement of the TBAs and other community health workers in the mainstream healthcare system was part of a larger effort to encourage hospital visits in a country which has one of the highest maternal and infant mortality rates in the world. TBAs were thought to be at the heart of the problem as they presided over home deliveries, which was blamed for the many deaths of women while giving birth or their infants.
NMDHR says its latest findings indicate that bye-laws instituted to discourage home deliveries have been rendered ineffective due to fear of Covid-19.
NMDHR says it deployed community paralegals who provide legal education and verifiable information about COVID-19 to reduce misconceptions, discourage fake news and wrong perception about the disease in rural communities. The paralegals visited 17 of the district’s 17 PHUs and collected data at various health posts/centers on and conducted interviews with FHCI beneficiaries and in-charges of the health facilities.
“While these actions are contributing positively towards stopping community transmission of the virus, the health system is already facing its own challenges to meet the health needs of non-covid-19 positive healthcare beneficiaries,” the report notes.
“Generally, the number and frequency of free healthcare beneficiaries seeking antenatal and postnatal care, family planning services, birthing services, child growth monitoring, immunization, health education visit to PHUs dropped sharply since the first case of COVID-19 was recorded in the District,” the report adds.
“Interestingly, there is 50% increase in availability of FHCI Drugs. This may be partly due to the low levels of visits at health posts/centers by key free health care beneficiaries,” it goes on.
The study also revealed a 30% increase in availability of WASH facilities at PHUs. Crucially, it notes a “sharp decrease” in the number immunization outreach/bed nets distribution conducted by CHOs across the 17 PHUs surveyed.
NMDHR says these findings imply that communities were losing trust in their local health structures due to fear of the ongoing viral pandemic which is ravaging the globe.
Kailahun, located in the easternmost part of the country, is one of the most deprived districts. It is known mostly for agricultural activities.
Kailahun was one of the hardest hit districts in Sierra Leone by the 2014-2016 West African Ebola epidemic, which had a devastating effect on health service delivery in the country. That epidemic started in Guinea and then spilled over to Liberia before entering Sierra Leone through Kailahun.
Sierra Leone recorded its first of case of Covid-19 on March 30. As of June 3, it has registered a total cumulative positive cases of 909.
As of the same period, only one out of the country’s 16 districts – Karene – hasn’t recorded a case. Kailahun, one of the last districts to register a case, currently has 19 cumulative positive cases.
NMDHR says since then primary healthcare delivery has been adversely impacted.
“The challenge is whether the District can improve the coverage of health services with the current level of COVID-19 community transmission, concern over low hospital visit, fear in the public on contracting Covid-19, low health sector investments, especially at the close-to-beneficiaries PHUs,” the report notes.
The Kailahun District Health Management Team (DHMT) is responsible for overall planning, implementation, coordination, monitoring and evaluation of district health services. Its head, the District Medical Officer, Dr Desmond Maada Kangbai, told Politico that he hasn’t seen a copy of the report yet and so couldn’t comment on it.
NMDHR’s Freetown-based National Coordinator, Abdul Karim Habib, said they couldn’t present a copy of the report to the DHMT because of the Covid-19 restrictions which have prevented them from traveling.
“Most of what we do now is virtual,” he told Politico, noting that they intended ot share the report with the district health authorities eventually.
The organization recommends that the government engage in partnership and empower communities to lead the fight at their level.
“NMDHR believes that taking a multi-sectoral and partnership based approach is critical in preventing and controlling the spread of the disease especially in rural communities. Additionally, empowering communities and grassroots organizations to lead the fight is key to reducing the high levels of lack of trust in health services at this critical time,” it said.
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