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.