Sierra Leone at 63: Focus on Public Health

Sierra Leone Flag with "Sierra Leone at 62" written on the white section

Happy Independence Day to Sierra Leone! While we celebrate Independence Day or should we be celebrating? During one of the events First Lady Fatima Maada Bio at Harvard she says that we should not be celebrating independence as we are not free. What are your thoughts on celebrating independence? (video timestamp: 7:30)

To me, Independence Day is a time to reflect, track progress, and highlight areas that need further work. This is exactly, the purpose of this post as I will share some public health milestones and areas for improvement. Last independence day, the milestones included reducing maternal mortality, a health financing report, the introduction of the HPV vaccine, and the GEWE Act. Areas for improvement included non-communicable diseases, the Kush epidemic, electricity at hospitals, and the healthcare workforce.

Let us start with the milestones.

1. Strategy Launches & New Climate-Health Unit: This year there have been several strategy launches. In June 2023, the Sierra Leone Child Survival Action Plan was launched and a milestone for preventable child deaths was also reached. There was the launch of the first National Health Supply Strategy 2023-2027 which looks at a cost-effective way to meet supply chain needs and recognizes that this has historically been through high dependence on external support. With all these strategies launched, implementing them and monitoring and evaluating this implementation should be next on the list. In April 2024, the Ministry of Health and Sanitation also launched its first climate-health unit. This is a great step to ensure planning for the impacts that climate change will have on health, particularly following the 2017 mudslide. Climate change will also impact patterns of disease infection, particularly for malaria.

2. Arrival of Mercy Ships: In August 2023, Mercy Ships arrived in Sierra Leone. The arrival of these ships starts a 3-decade partnership between Mercy Ships and Sierra Leone. Mercy Ships runs fully operational hospital ships equipped to perform many procedures which are provided for free recognizing financial barriers that exist for patients to access care. The ships are intended to provide free surgical care for conditions like cleft lips and palates, burn contractures, orthopedic malformations, benign tumors, and cataracts. Mercy Ships also aims to contribute to the public healthcare workforce by training over 200 health professionals such as medical technicians, nurses, and surgeons. These are promising developments to increase care to patients while also contributing to the public health workforce. Sierra Leone's health workforce falls below the World Health Organization (WHO) recommendation of 23 health workers per 10,000 population. The 2021 - 2025 National Health Sector Strategic Plan (NHSSP) indicates that the health workforce in the country is 6.4 per 10,000 population. 3. National Public Health Agency: Since 2015, there have been discussions to launch a National Public Health Insitute in Sierra Leone. These discussions followed the devastating Ebola Outbreak and included The International Associations of National Public Health Institutes, the US Centres for Disease Prevention and Control, and Public Health England. In December 2023, The Sierra Leone National Public Health Agency (NPHA) officially launched. The NPHA has the following objectives (1) Strengthening the Public Health System (2) Workforce Development (3) Financial Coordination. 4. Electricity at Hospitals: Another development that directly responds to an improvement I suggested last year was the increase in electricity at health facilities. 6 hospitals, including the Princess Christian Maternity Hospital (PCMH), Ola During Children’s Hospital (ODCH), Bonthe Government Hospital, Kambia Government Hospital, Kabala Government Hospital and Masanga Hospital have started to use renewable solar power. This has been possible through the Sierra Leone Healthcare Electrification Project funded by the United Kingdom's Foreign Commonwealth and Development Office (FCDO). This project also provides employment opportunities and training opportunities with a focus on women. The goal is that 11 more hospitals will have electricity.

Thank you @PresidentBio for lighting up 6 government hospitals, that were officially launched today, with 11 more to come. #MoH @DembyAustin and partners are determined to electrify hospitals using renewable solar power. There is hope for quality healthcare delivery in 🇸🇱. pic.twitter.com/9xcEBHwrJU

— MoH (@mohs_sl) January 25, 2024

These are all great steps by the Ministry of Health and its partners to improve healthcare access and health outcomes. And while progress has been made, there are still areas for improvement. Some of them are below.

1. Sanitation at Healthcare Facilities: A World Health Organization (WHO) report tracked the progress in sanitation at health facilities from 2000 to 2021. In 2021, only about 20% of urban and rural health facilities had basic water services and in 2018 only 22% of facilities had piped water. Water and sanitation are important to promote infection prevention and control, ensure environmental cleaning of facilities, and waste management. Improved sanitation at facilities can help reduce the spread of infections.

2. Kush Epidemic: In April 2024, the President of Sierra Leone declared a National State of Emergency on the Kush epidemic, which involved the establishment of a national task force on substance abuse made up of various stakeholders. The declaration came 2 months after the declaration of Kush as a Public Health Emergency in neighboring Liberia. This issue has been ongoing for a while (I wrote about it in last year's Independence Day post). To improve the situation, it is important to tackle the issue using a public health lens, which entails understanding the root cause of the problem, community engagement, and using a health and human rights approach. It is also important to work with people who use Kush and protect the safety of those individuals to understand factors leading to drug use and how to best help these individuals. While engaging with people who use Kush, it is important not to stigmatize these individuals.

3. Female Genital Mutilation/Cutting: In January 2024, 3 girls Adamsay Sesay, 12; Salamatu Jalloh, 13; and Kadiatu Bangura, 17 died after being cut. Female Genital Mutilation/Cutting (FGM/C) causes harm to the bodies of girls and women. Immediate and long-term harms include complications in giving birth, urinary problems, death, and menstrual problems. These deaths are often covered up thus, addressing FGM/C and protecting women and girls' bodies requires a community approach.

4. Malaria: Malaria is the highest cause of death for females and the third highest for males. Malaria accounts for 2 million hospital deaths annually and 25% of all child deaths. In December 2023, Sierra Leone received its first batches of the RTS,S malaria vaccine. This vaccine's efficacy is very short and decreases to 11% at 1 year from 63%. In addition to a vaccine, malaria also needs a government-wide approach to address unsanitary drinking water and conditions that increase the risk of malaria.
   

I hope you enjoyed this summary of some progress and areas of improvement in public health. As we improve the health system, we should also remember the milestones reached.