Free Healthcare in Sierra Leone: More Than Just a Slogan

Human Capital Development

Free Healthcare in Sierra Leone: More Than Just a Slogan

Posted on: 26th April 2011

This month I returned to Sierra Leone for the first time in two years. It was a special moment to go back. The country is celebrating 50 years of independence from colonial rule, and there was a palpable sense of optimism in the air, stemming not just from anticipation of week-long national celebrations, but also from pride in what the country has achieved, and pride in the changed face of Sierra Leone now being presented to the world. 

There is a lot to celebrate. Free and fair elections. Stability and peace restored after the brutal decade-long civil war which left tens of thousands dead and more than a million displaced. A business- orientated government rebuilding the country so that it can look forward with optimism once again. Electricity in Freetown for the first time ever. Investment coming in to transform the country’s infrastructure and create jobs. And better life chances for the hundreds of thousands of women, and their young children, treated in government hospitals since user fees were abolished for them exactly a year ago.

It is this last achievement which resonates with me most. Since I last visited Sierra Leone, I gave birth to twin boys. Before free healthcare was launched, for every 100,000 births in Sierra Leone, around 900 mothers died, compared to only 12 in the UK.  The probability that a 15 year old girl would die eventually of a maternal cause was 1 in 21 – in the UK it is 1 in 4,700. And the chances of a child in Sierra Leone dying before their fifth birthday were 1 in 7. As a new mother I felt the reality of these statistics acutely. Our approach at the Africa Governance Initiative – helping African governments to turn their vision for change into practical results, which will lead our partner countries away from aid dependency – was an important part of making free healthcare more than a slogan in Sierra Leone.  Our team  worked with the Ministry of Health to build capacity in the “nuts and bolts” of delivery – the mechanics of government needed to make a complex policy like this a reality.

Since the launch of Free Healthcare a year ago with the donors’ support, including from the UK Department for International Development, almost three times as many under-5’s were treated in government health facilities than during the previous 12 months. Initial government data suggests that this increased access to treatment has led to an astonishing 80% reduction in child deaths from malaria, and a 60% reduction in maternal mortality in hospitals. And behind these statistics, the stories – like the young boy whose twin brother died a week before free healthcare was launched, but who managed to hang on until the 27th April and so got the treatment he needed to survive.

The credit for this change goes to the many remarkable, dedicated, people in Sierra Leone’s health system. At AGI we are proud to have worked with them for the past two years. But the story is far from over. Whilst in Freetown, I met Zainab Bangura, Sierra Leone’s Health Minister. Zainab has long been a personal inspiration to me. Fifteen years ago, as the country’s civil war raged, she was targeted for assassination by rebels from the Revolutionary United Front for her forceful campaigning for peace and democracy. Now she applies her fearless, no-nonsense approach to transforming Sierra Leone’s health system. Yes, things have improved in recent years. But she is the first to admit that there is still much, much more to do. Sanitation is a major challenge - 40% of the population still don’t have access to clean drinking water and 86% don’t have access to adequate toilet facilities. Healthcare might be free at Freetown’s main maternity hospital, but it doesn’t have running water. Outside Freetown the country has almost no power. All too often the drugs that would save lives aren’t available when and where they are needed. And in a country with amongst the worst maternal and child mortality in the world, there are only three paediatricians and four obstetricians in government service in all of Sierra Leone. The list goes on. Of course, the challenge here is about resources. But with such strong commitment to healthcare from the international aid community, it is also about how the country’s inspirational leaders - like my friend Zainab – can translate their vision for change into practical results, and what we in the developed world can do to support them. Aid alone is not enough. We have to work with African governments to make country ownership more than a watchword.


The work described here was carried out by the Tony Blair Africa Governance Initiative, it is now being continued by the Tony Blair Institute for Global Change.


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