1. CONSTRAINTS TO PRIMARY HEALTH CARE DELIVERY THE GOVERNMENT OBJECTIVES FOR DELIVERING PHC SERVICES To increase accessibility to quality health care services Make services for the majority of the population To build capacity and update knowledge of staff To contribute to the reduction of infant and maternal mortality To Improve sanitation thereby reducing the impact of communicable diseases

2. NATIONAL HEALTH PRIORITY PROBLEMS Malaria Sexually transmitted infection including HIV/AIDS Tuberculosis Unsatisfactory reproductive health including maternal and neo-natal mortality Childhood immunizable diseases Nutrition related disease Water, food and sanitation- borne disease Disability Mental illness

3. PRIMARY HEALTH CARE DELIVERY MECHANISM Multiplicity of health service providers (i.e. Government, International NGOs, Private Sector, Voluntary Sector and Traditional Services) Government accounts for 70% of services provided General population utilisation rate is estimated at 0.5 % per capita per annum Half of the population attends a health care facility once a year Nurses provide 70% of PHC delivery services Over reliance on institutional-based care (i.e. Services delivered at clinics rather than within the community)

4. CONSTRAINTS ON PRIMARY HEALTH CARE DELIVERY ACCESSIBILTY AND AFFORDABILITY WHO recommends that health facilities should be located at least 8km from major settlements Only those who can afford to travel or pay for private treatment have access to PHC services Physical distances to PHC facilities is a major barrier Uncoordinated systems of community health service Community health staff are unable to reach vulnerable users (i.e. Children, expectant mothers, physically challenged and senior citizens) Cost of health service provision – meeting the needs of vulnerable groups) Affordability - applying the user pay principle

5. ACCESSIBILITY – ROLE OF TRANSPORT The availability of transport means that poor people particularly in rural areas will access health services. The increasing use of unlicensed and untrained health care providers (locally known as pepeh doctors’) is a direct result of the lack of transport for people requiring treatment for routine ailment. Thus the low level of attendance within established health centres Lack of transport could also affect planned community health support programmes such as immunisation, malaria control and health education The expansion of outreach relies on the adequate provision of transport for nurses and community health workers. Without improved out reach most people will be marginalised and would resort to alternative means of cure which in some cases may lead to fatalities.

6. IMPROVING ACCESS – THE NEED FOR A PROPERLY MANAGED HEALTH TRANSPORT AND LOGISTICS SYSTEM It is the means through which services are delivered to the public and other internal stakeholders The most frequently given reason for non-delivery of services is that there is no transport available Service delivery departments and donors across the world spend large amounts of capital and recurrent funds providing transport resources Transport is frequently one of the largest budget items. In some countries it can represent 20-30 percent of budget after salaries have been paid When funding for more vehicles is found, it often happens that the expected increase in service delivery fails to materialise

7. IMPROVING ACCESS – THE NEED FOR A PROPERLY MANAGED HEALTH TRANSPORT AND LOGISTICS SYSTEM Effective management of transport has much greater impact on service delivery than the provision of new vehicles Everybody has a key part to play in making a success of the Ministry/Department’s targets against measurable performance indicators, achieved through team-work and participation Transport is required to provide access to immunisation services, delivery of medicines and drugs, distribution of ARVs, disease control and health education and nutrition advice services The Key question is how do we pay for the services and are there mechanisms for improved management

8. TRANSPORT FOR THOSE WHO CAN AFFORD IT. IS IT SAFE OR APPROPRIATE?

9. AFFORDABLE MEANS OF TRANSPORT

10. DIASPORA INTERVENTION FOR IMPROVING ACCESSIBILITY TO PRIMARY HEALTH CARE SERVICES Coordinating primary health care delivery services in line with government priorities Fundraising activities to support delivery services Project Prioritisation – Focusing on meeting the Millennium Development Goals Health Targets (i.e. Reduced Maternal and Child Mortality, Disease Prevention and Reducing the impact of communicable disease i.e. HIV/AIDS, TB etc) Set up a development fund for specific projects – Every Health Clinic should have an affordable means of transport e.g. Motorcycle ambulance to improve access to Emergency Obstetric Care Skills development – Supporting and training community health workers to improve outreach

11. SIERRA LEONE DIASPORA NETWORK THANK YOU FOR YOUR ATTENTION VICTOR MENGOT SLDN HEALTH SECTOR COORDINATOR