C ommo nwe a l t h memb e r c o u n t r i e s There are about 80 hospitals in the public and private sectors in Sierra Leone. The facilities include 17 government civilian hospitals, with a key private hospital, Choithram, in Freetown. Other, temporary hospitals have been opened to treat Ebola patients, usually funded by charities or foreign governments. The largest mission hospital in the country is the Emergency Hospital established by the Italian non-governmental organisation (NGO) Emergency, and a key medical training facility is the College of Medicine and Allied Health Sciences (COMAHS). There is also a thriving market for traditional healers in Sierra Leone. The Hospital Boards Act 2003, followed by the Hospital Boards Amendment Act 2007, came into operation to ensure the better management of specified hospitals and the provision of efficient medical care in the country. A fledgling pharmaceutical industry has sprung up in the last few years, but the country still imports the vast majority of its drugs, with the Pharmacy Board monitoring the quality of incoming medicines. Sierra Leone’s pharmaceutical sector mainly consists of retailers, marketers and local agents of the big international pharmaceutical firms. The Pharmacy Board has been involved in a series of efforts to stamp out the proliferation of counterfeit medicines, which continue to pose a threat to the pharmaceutical industry and public health in the entire region. The current mental health laws under the Mental Treatment Ordinance have been in place since 1957. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Sierra Leone to achieve its targets for the reduction of child mortality, which forms MDG 4, it should have reduced under-five deaths per 1,000 live births to 89 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 161 deaths per 1,000 live births – almost double the target figure – and measles immunisation at 83 per cent. It is unlikely, therefore, that the under-five target will be met. Measles immunisation coverage would need to be expanded by nearly a fifth to meet the target. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Sierra Leone, the maternal mortality ratio should fall to 325 cases per 100,000 live births. In 2013 Sierra Leone had an adjusted maternal mortality ratio of 1,100 deaths per 100,000 live births (this figure was estimated at 890 deaths per 100,000 by UN agencies/World Bank in 2010). Sierra Leone would have had to cut maternal mortality by twothirds in just two years in order to meet this target. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2010 this figure stood at 61 per cent, so achievement of this target is also looking unrealistic. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. There has been little change in HIV prevalence in Sierra Leone since 2004, with incidence of HIV having increased significantly since records began around 1990. Reported cases and deaths from malaria in the country are also high and continuing to rise. Unfortunately, there has been a significant increase in the estimated incidence of and estimated mortality (when mortality data excludes cases comorbid with HIV) from TB since 1990. Consequently, this goal is unlikely to be reached. The United Nations Development Programme report on Sierra Leone’s progress towards the MDGs suggests increasing awareness and education about diseases in the general population, and improving the facilities of health care centres and hospitals to allow for increased treatment of these diseases. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Less than a fifth of health care in Sierra Leone (17 per cent) was government funded in 2012. The remaining 83 per cent was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted 15.1 per cent of GDP in 2012. Expenditure by government amounts to US$16 per capita. In 2010 the government brought in the Free Healthcare Initiative for pregnant women, breastfeeding mothers and children under five. Fees for medical attention were abolished for these target groups, with drugs and treatment provided free of charge in every public health facility in the country. Sierra Leone was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1996 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: Around 162,000 people in Sierra Leone are over the age of 65 – three per cent of the total population (2013). At the age of 60 a person living in Sierra Leone can be expected to live for an additional 13 years, on average (2013). Overall, public pension spending is equivalent to 0.5 per cent of the country’s total economic output (2009). Like in many other African countries, the elderly are traditionally cared for by family, but AIDS and the civil war have seen many older people outlive their children. Charities provide some care for elderly people. The King George VI Coronation Home for the Elderly in Freetown, for example, is the country’s only facility of its kind and is heavily dependent on help from international charities. Further information Ministry of Health and Sanitation: www.health.gov.sl Commonwealth Health Online: www.commonwealthhealth.org/health/africa/sierra_leone 260 Commonwealth Health Partnerships 2015 Population over 65 3%
Commonwealth Health Partnerships 2015
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