1. LANCET COMMISSION PRESENTATION HEALTH CARE DELIVERY SYSTEM IN SIERRA LEONE BY DR EVA HANCILES

2. THE PRESENT

3. NUMBERS OF CLINICAL STAFF IN GOVERNMENT HOSPITALS Professional GroupNumbers Qualified O&G4 Orthopaedic Surgeons0 General Surgeons7 Paediatric Surgeons0 Urologists1 Anaesthetists4 Physicians, 70 nurse anaesthetists ENT1 (Overseas doctor) Dentists2 Ophthalmologists1 Radiologist1

4. CHALLENGES TO EFFECTIVE SURGICAL SERVICE DELIVERY Paucity of trained surgeons. Lack of trained Paediatric surgeons for congenital abnormalities. Increased demand after introduction of ‘Free Health’ services. Low acceptability of surgical services Lack of affordability by the community Lack of equipment and consumables.

5. CHALLENGES CONT. Lack of 24hr diagnostic services. Inadequate blood bank services. Lack and poor maintenance of equipment and infrastructure. Lack of/poor Oxygen supplies Poor road & communication network, ambulance services Ineffective MOHS procurement processes

6. BROAD ROLE OF NGO RUN HOSPITALS AND RELATIONSHIP WITH GOVT. PROVIDERS Type of service provision. Coordination with /independence from government hospitals. Outside engagement of trainee and specialist surgeons. Lack of cohesion of staff training.

7. PERI AND POST-OP CARE Paucity of specialist theatre nurses. Very few trained critical care nurses. Lack of recovery room facilities Poor post-op wound care on surgical wards Inadequate pain relief Inadequate physiotherapy & rehabilitation services

8. SURGICAL SAFETY Safety equipment not always available Inadequate training. Ineffective sterilisation Need for Adoption of peri-operative checklists Clinical Audits/M & M meetings

9. THE FUTURE

10. POST GRADUATE SURGICAL TRAINEES Due to qualify / return home between 2014 and 2017 O & G- 5 Ophthalmology -2 Radiology- 3 General Surgery-5

11. SYSTEMS AND INFRASTRUCTURE CASE STUDY- CONNAUGHT HOSPITAL CREATING A CULTURE OF IMPROVEMENT WITHIN THE HOSPITAL e.g improving the capacity within the F&M department the institution of a technical committee for the procurement of goods and services. improving the processes for internal revenue collection.

12. TASK SHIFTING/TASK SHARING Eg, National Training of Nurse Anaesthetists & Anaesthetic Technicians. NGO hospital training of non- doctor surgeons. ? Plans for supervision, updates.

13. LEADERSHIP ROLES IN HOSPITALS Need for specific general management skills Need for greater autonomy in tertiary hospitals Effective annual Budget planning

14. KEY MESSAGES Clear clinical and managerial leadership structures with defined roles and responsibilities. More effective utilisation of financial resources Coordinating patient pathways to improve quality of care delivered and patient experience.

15. THANK YOU