The current Ebola virus epidemic in Sierra Leone is highlighting persistent gaps and deficiencies in the country’s health care system. These same deficiencies also contribute to the death of approximately 1,100 mothers a year per 100,000 live births.
The current Ebola virus epidemic in Sierra Leone is highlighting persistent gaps and deficiencies in the country’s health care system. These same deficiencies also contribute to the death of approximately 1,100 mothers a year per 100,000 live births[1]. Since the start of the Ebola epidemic on 20 May and as of 15 July 2014 the cumulative number of deaths is 118, whilst an estimated 400 mothers have died during the same period from entirely preventable reasons. Poorly resourced health systems contribute to mortalities along the whole spectrum of stresses put on the system and in the case of Sierra Leone these stresses include both Ebola and maternal and newborn mortalities.Since the Free Healthcare Initiative (FHCI) was launched in 2010 by the Government of Sierra Leone, progress has been made on its priority interventions.Since its inception in April 2010, more pregnant women are accessing free healthcare and increasing the demand for services. However, supply of health services has not kept up with this demand and the system is struggling to cope[2]. Providing access to health services is not enough, but quality of health services needs to be improved to ensure mothers and babies survive. Persisting quality of care deficiencies in the health care system in Sierra Leone include those of skills shortage and high turnover of health care staff; lack of equipment, medication and laboratory services; and non-functioning health centre facilities. These same deficiencies result in the health system’s inability to respond to health emergency outbreaks such as that of the current Ebola outbreak and the cholera outbreak which killed 392 people in 2012.Most of these deficiencies can be improved by ensuring the Sierra Leonean government allocates more funding to health in their National Health Accounts. Sierra Leone has committed to the Abuja Declaration of spending 15% of its total budget on health, however these commitments are lagging behind with only approximately 10.5% of its total budget spent on health in 2013[3]. Commitments start with transparency on both allocation and spending on health, however, a recent scorecard on health transparency here shows that Sierra Leone is inadequately transparent on four indicators and requires more transparency on one. The government needs to ensure that there is a transparent allocation to health in budget proposals; transparent spending on health; spending is linked to health outcomes; the budget information is clearly communicated to the public and that the budget timetable for preparation and publication is adhered to.We need to consider the Ebola outbreak as well as the ongoing maternal and newborn mortalities holistically by strengthening the health care system which supports prevention of both. With this in mind, we call for government of Sierra Leone to consider health as a national priority and to transparently allocate more funding to health for the survival of mothers and babies.[1] www.who.int/gho/maternal_health/countries/sle.pdf?ua=1[2] www.mamaye.org.sl/en/blog/mothers-and-babies-sierra-leone-need-better-quality-care[3] www.mamaye.org.sl/en/evidence/sierra-leones-commitment-abuja-target