To my Salone fambul, Happy Independence Day! While we celebrate independence day and where our country is today, there's been progress in public health in the last year. I am going to share four milestones.
Health Financing: In April 2022, Sierra Leone released its Health Financing Report and it is the first country in the world to do so. The report highlights the challenges to leading health financing reforms. This report was created using only in-country experts, enabling local knowledge and agency in the creation of the report. The report proposed 48 recommendations and also recognized that each country's path to UHC is unique. The main assessment areas were: pooling revenues, purchasing and provider payment, benefits and conditions of access, public financial management, and public health functions and programs. *Update: The Report was published in April 2021 and revised in September 2022 although it was published on the Financing Health in Africa Blog in April 2022. Sierra Leone is the first country in the world to use solely in-country experts.
Public Health Surveillance: In August 2022, the World Health Organization (WHO) revealed that Sierra Leone has made significant progress to achieve targets of the WHO regional and global public health surveillance indicators. The WHO Representative in Sierra Leone stated that the quality of weekly data reported from all public health facilities across the country has significantly improved. The Ministry of Health and Sanitation through the Directorate of Health Security and Emergency and the National Disease Surveillance Programme with support from partners tracks priority diseases, searches for active cases, and collects specimens for laboratory investigation. A workshop on public health surveillance data was also held to improve the quality of data in the country. This kind of public health surveillance system enables real-time tracking of outbreaks which is needed. Development partners tend to focus on changes over time to show program progress, which was discussed at the 2022 AfriMS Symposium in Sierra Leone.
Human Papillomaapiollma Virus (HPV) Vaccine: In October 2022, the Ministry of Health and Sanitation with support from GAVI, UNICEF, and WHO introduced the HPV vaccine into the routine immunization program. This vaccine will be administered to 153,991 10-year-old school girls through schools, protecting them against cervical cancer. Globally cervical cancer is the fourth most common cancer among women while in Sierra Leone it is the second most common cancer in women. According to the Sierra Leone Global Cancer Registry, it leads to the highest number of cancer deaths. This project was initially piloted in Bo District in 2014, but due to the Ebola Outbreak and COVID-19 Pandemic a nationwide administration was delayed. This will contribute to minimizing cervical cancer deaths.
Gender Equality and Women’s Empowerment (GEWE) Act: In January 2023, the GEWE Act was signed into law. This Act sets a quota of 30% for women's participation in government for appointed and elected positions, women get 14 weeks of maternity leave, amongst other benefits. It has also been reported that there will be fines of 50,000 Leones if the quota is not met. This is a step taken to ensure gender equality as women are represented in the public and private sectors. *Update: I would like to clarify that there are discrepancies between what the Act states and the public's understanding of the Act. View this press release for more information.
This is progress to be applauded as they will improve the accessibility to health services, enable the tracing of outbreaks, and also minimize cervical cancer deaths. As we look to the future and elections are coming, there are several issues that need improvements to safeguard population health.
Kush Epidemic: Sierra Leone is currently witnessing a Kush epidemic and it is killing many youth in the country. Kush refers to a pure or hybrid form of cannabis, the hybrid form can be deadly as it is unclear which substances are mixed with it. While there are no recent studies on this there are documentaries highlighting the impacts in the country. One is a BBC Africa Eye documentary that details this issue. This issue needs to be urgently addressed. *Trigger warning due to references to abuse, and suicide in the documentary
Electricity: According to United Nations Office for Project Services (UNOPS), only 26% of Sierra Leone's population has access to electricity. Many health facilities lack electricity as 38% of health facilities lack power and the 62% that do have power suffer from insufficient and unreliable power. This leads to challenging working conditions pushing many medical staff out of the country.
Healthcare Workforce: A study in the British Medical Journal on the health workforce in WHO Africa Regional Office (AFRO) estimates that Sierra Leone has a total of 8054 healthcare workers. The density of doctors, midwives, and midwives in the whole country is less than 1.00 per 1,000 population according to the study. Most of these healthcare workers are concentrated in the Western Area, leaving the rest of the country with few health professionals. It is vital to address the retention of workers and ensure an equitable distribution of the healthcare workforce in the country.
Non-communicable Diseases (NCD): Sierra Leone is seeing a rise in the prevalence of non-communicable diseases such as hypertension, cardiovascular diseases, and diabetes. WHO AFRO estimates that NCDs account for 18% of all deaths in Sierra Leone and there is little capacity to respond to them. There is a visualization of NCD deaths between 2018 - 2020 created by Tahir Bockarie, revealing that most deaths are from cardiovascular diseases. Alcohol and tobacco are widely used which are two modifiable risk factors that can minimize NCD prevalence.
While we look back on progress in public health, there is still more work that needs to be done to ensure a better country for everyone.