As the efforts to reduce the child and maternal mortality rate throughout Sierra Leone continue, improvements are already being reported in Connaught Hospital, Freetown. In 2008, Connaught Hospital received 15,080 patients, of which 533 died (mortality rate of 3.5%). In 2007, there were 10,079 patients and 459 deaths (mortality rate of 4.5%). While the mortality rate difference of 1% is not overwhelming, the statistics behind the hospital’s work are.
Ibrahim Turay, manager of Connaught Hospital, stated that the hospital received 32% more patients, and 35% more surgical procedures in 2008 than in previous years. A decrease in mortality rate coupled with an increase in patient cases is an achievement for this busy medical center, the main government hospital of Sierra Leone. According to Mr. Turay, the improvements in care are due mostly to the addition of diagnostic tools, including an ECHO cardiogram machine and a CT scanner. Improvements in the forensic lab, diagnostic units, and water supply are slated for 2009.
African Union (AU) Commissioner for Social Affairs, Biencé Gawana, insists that African countries should focus on promoting maternal, infant and child health and reporting on progress. During a summit on child and maternal health in Addis Ababa, Ethiopia, the members of the AU agreed to create a continent-wide campaign to stress the importance of child and maternal health. While Africa has some of the highest rates of maternal, infant, and child mortality, progress is being made. As information and communications technology and innovation continue to grow, health officials are certain that the improvements to maternal, infant and child health will be “paramount”. In addition, the AU has proposed a pharmaceuticals manufacturing plan, which will allow countries within Africa to produce their own drugs and medicines.
In the hope of reducing child and maternal mortality, which are key indicators of the health of any community, 60 nursing aides in Sierra Leone have recently been awarded certificates for passing a course specifically educating them in child mortality. While there is a lack of qualified health workers willing to work in health throughout Sierra Leone, the graduation of these 60 nursing aides shows that Sierra Leone has heeded the advice of the AU, and has taken steps to assure that infant, child, and maternal mortality decreases over time.
In 1997, Dr. Andre Briand noticed that the nutritional balance of proteins, lipids, and calories in a popular chocolate spread was similar to therapeutic meals used to treat children suffering from severe malnutrition. Two years later, Plumpy’Nut was born. (click here for transcript of an interview with Dr. Briand)
Dr. Briand, a French pediatrician, had been searching for a method to supply malnourished children with the nutritional equivalent of therapies recommended by the World Health Organization (WHO). While these suggested diets worked extremely well, it was impossible to reach a wide population of children because the special combination of meal powder, oil, sugar, vitamins and minerals required the use of clean drinking water to prepare (an ingredient often unavailable in villages throughout the world).
Plumpy’nut is a Ready-to-Use Therapeutic Food (RUTF) contained in individual packets, usually foil pouches. RUTF packets are administered to children regularly, and requires no addition of any materials, which reduces the risk of bacterial infection. Plumpy’nut is also convenient for home administration: allowing health workers to follow the progress of children receiving treatment, but also freeing space in normally overflowing treatment centers and hospitals. Plumpy’nut is also being produced in Africa, which reduces the cost of distribution and creates a sense of self-sufficiency and control among the populations that need food therapy the most.
Anderson Cooper interviewed Dr. Milton Tectonidis, a nutrition specialist with Doctors Without Borders for 60 Minutes. Dr. Tectonidis states, “It’s a revolution in nutritional affairs. … Now we have something. It is like an essential medicine.”
The Sierra Leonean government is considering introducing a health care plan that would combine a national insurance plan with completely free care for the nation’s neediest groups. The implemented plan would fund basic health care through insurance premiums, taxes (on such items as alcohol and cigarettes), contributions from citizens, and donors. The UK’s Department of International Development (DFID), has pledged to back Sierra Leone’s government in providing free health care. Children, pregnant and lactating women, and the destitute would be exempt from premiums. While Sierra Leone already has a policy that includes free health care for children and pregnant women, they have been unable to provide the care, due to lack of financing. Children and pregnant women have been subject to “informal fees” - mostly because the few health care workers are paid very poorly, or often not at all.
The insurance plan would be administered by the existing National Social Security and Insurance Trust (NASSIT). According to NASSIT, the new health insurance plan would be phased in by district, but creating and implementing a sustainable system will take approximately 10-20 years. Médecins Sans Frontières (Doctors Without Borders) and Save the Children are also working with the government to improve access to quality health services. Health Minister Dr. Kabia says, “We will not rest until our [women] and children stop dying.” (Full story)
In areas where there are low levels of electricity, literacy, and the availability of health information, it may now be possible for rural villagers to accurately track health information by counting stones. For more than a decade, the University of Oslo, Norway has created health information systems for countries throughout Africa. Sierra Leone, with its low health ratings, recent civil war, and virtually non-existent power grids in rural villages, is the University’s latest project. In Tobodu, eastern Sierra Leone, the traditional midwives of the village place stones in a box that has five compartments. In this way, the box registers births, stillbirths, post-birth death of a child, post-birth death of a mother, and illness of a mother. These key indicators of health are then counted monthly by the local health center, and passed along to the district authorities. The information is logged in a regional database, which is a part of the national system.
In August, 2008, Sierra Leone’s Minister of Health and Sanitation, Dr. Soccoh Alex Kabia, unveiled a “revitalized district health informations system,” with the goal of documenting and producing information on key health indicators. With funding from the World Health Organization and the Health Metrics Network, all 13 districts in Sierra Leone are being provided with low-powered computers that operate on solar energy to create a nation-wide system to document information that will directly influence the decisions of health officials. “This will help us reduce the high mortality among children and pregnant women…by contributing to move to evidence-based planning and decision-making at local levels, transparency and accountability and regular monitoring of progress made in the sector,” said Dr. Kabia.
