Health system is the total of all organizations, institutions and resources whose primary role is to improve health. The functions of the health system are good health, responsiveness to the expectations of the population and fairness of financial contribution.
Sierra Leone’s health system is organized into two: the Peripheral Healthcare Units (PHUs) with community health programmes, and Secondary Care that involves 21 district hospitals and three referral hospitals(Robinson, 2019). The country’s capital Freetown has private clinics and private hospitals. The PHUs are divided into the child, and lab assistants and environmental health workers assist maternal health posts, community health posts that are run by State-Enrolled Community Health Nurses, and Community Health Centres that are managed by the community health officers.
The country has a significant shortage of skilled Human Resource for Health (HRH) with an inadequate, skewed distribution of the health workforce(Robinson, 2019). As shown in figure 1, the majority of the people reside in rural areas, and ironically the majority of the HRH is based in the urban area. The trend is similar to that observed in most other African countries’ health systems(Robyn et al., 2015). Most health care providers consider rural posting non-desirable because of insufficient financial and non-financial incentives, and also due to the increased workload. The few HRHs that remain in the rural health centres are under-equipped, receive less training and record low employee job satisfaction ratings.
Figure 1: Skewed distribution of the Health Workforce between Rural and Urban Centres in Sierra Leone
Health System
A study showed that about 90% of all surgeons found in the country are located in the capital city, Freetown(Robyn et al., 2015). The unequal distribution of health services in the country indicates that the health care system is weak and amends are required to achieve maximal health coverage for all. In the Ebola 2014-2016 epidemic, the country relied on international collaboration and support to overcome the strain on its health system(Maxmen, 2020). Lessons learned from the epidemic proved to help the country early on during the outbreak of the COVID-19 pandemic response, but spikes in recent months have exposed the weak health systems.
Access to Healthcare Services
Access to healthcare services is the timely use of personal health services to achieve the best health outcomes. The term 'access' broadly applied may refer to the geographical distance to health institutions, the availability of the health institutions, affordability of health services, and the availability of the health workforce. Sierra Leone has 21 district hospital and three referral hospitals to serve a population of 7. 6 million citizens, the HRH-population ratio is approximately 0.4 doctors, nurses, and midwives per 10000 communities, far from the SDGs goal of 44 per 10000(Robinson, 2019). The ratio indicates a colossal deficit in HCWs. According to the Sierra Leone Demographic and Health Survey (SLDHS), the main barrier to access to healthcare is the cost of services. Most patients, especially those in the rural areas, prefer traditional medicine as evident with some Ebola survivors who had sought out conventional and conventional therapy for their treatment(SLIHS, n.d.). A different study showed that from a sample size of 134 pregnant women, 82.7% of them confirmed using traditional medicine to treat the associated urinary tract infections(James et al., 2019). Even with the free maternal and child healthcare initiative rolled out in 2010, some of the women in rural communities are still not able to access the services partly due to the distance from their homes to the district hospital being quite far.
In 2018, the government established the Sierra Leone Social Health Insurance to help improve financial accessibility and achieve Universal Health Coverage- SDG 3. However, there is not literature evidence of the impact of the SLSHI scheme in reducing out-of-pocket payments and improving health outcomes among the country's population. Other factors affecting access to health care in Sierra Leone include; chronic low funding and drug availability in health facilities with shortages and stock-outs. The heavy disease burden is mostly due to infectious diseases, seeing that they are the leading cause of mortality and morbidity with Malaria accounting for 38% of all hospital admissions, and Tuberculosis causing three new infections per 1000 persons every year. About 8706 people were affected by the Ebola virus with 3590 dying between May 2014 and March 2016.
References
2019 SLDHS. (2019). Sierra Leone Demographic and Health Survey 2019 Key Indicators Report. www.statistics.sl
Arora, S. (2001). HEALTH, HUMAN PRODUCTIVITY, AND LONG-TERM ECONOMIC GROWTH. The Journal of Economic History, 61(3), 699–749. https://doi.org/10.1017/S0022050701030054
Central Intelligence Agency. (n.d.). Africa :: Sierra Leone — The World Factbook . Retrieved October 4, 2020, from https://www.cia.gov/library/publications/the-world-factbook/geos/sl.html
James, P. B., Wardle, J., Steel, A., & Adams, J. (2019). Pattern of health care utilization and traditional and complementary medicine use among Ebola survivors in Sierra Leone. PLOS ONE, 14(9), e0223068. https://doi.org/10.1371/journal.pone.0223068
Maxmen, A. (2020). Ebola prepared these countries for coronavirus - but now even they are floundering. In Nature (Vol. 583, Issue 7818, pp. 667–668). NLM (Medline). https://doi.org/10.1038/d41586-020-02173-z
Robinson, C. (2019). Primary health care and family medicine in Sierra Leone. African Journal of Primary Health Care and Family Medicine, 11(1). https://doi.org/10.4102/phcfm.v11i1.2051
Robyn, P. J., Shroff, Z., Zang, O. R., Kingue, S., Djienouassi, S., Kouontchou, C., & Sorgho, G. (2015). Addressing health workforce distribution concerns: A discrete choice experiment to develop rural retention strategies in Cameroon. International Journal of Health Policy and Management, 4(3), 169–180. https://doi.org/10.15171/ijhpm.2015.27
SLIHS. (n.d.). Sierra Leone Integrated Household Survey (SLIHS). Retrieved October 4, 2020, from https://www.statistics.sl/index.php/sierra-leone-integrated-household-survey-slihs.html