1. The Background to Free Health Care Sierra Leone is evolving from the status of one of the least developed countries with the worst set of health indicators, which includes the intolerably high Infant, Child and Maternal Mortality Rates One of the priorities on the President’s Agenda for Change (PRSP II) is to address the unacceptably high child and maternal mortality and morbidity. (An Agenda for Change, 2008 – 2012) Current Figures o MMR = 875 /100,000 Live births o U5 MR = 140/1000 o IMR = 89/1000 o NMR = 34/1000

2. Free Health Service Delivery In Sierra Leone Dr. Samuel A S Kargbo Director, Reproductive and Child Health Ministry Of Health & Sanitation Sierra Leone 1 st June 2010 Madrid, Spain May 2010

3. Background (Continued) The National Health Sector Strategic Plan (NHSSP) aims to reach this goal through successful implementation of the Basic Package of Essential Health Services (BPEHS).  BPEHS specifies which services will be available at different levels of health facilities.  BPEHS focuses on cost-effective interventions, including emergency obstetric and newborn care, and preventive services such as family planning, immunization and the provision of long lasting insecticide treated bednets.  BPEHS will be rolled out over 2010 – 2011.  For this to succeed, barriers preventing Sierra Leoneans from accessing health care must be removed. This philosophy constitutes the basis for the FHCI

4. Barriers to Accessing Health Source: National Public Services Survey 2008

5. Strategy for Free Health Care On 27 th April 2010, His Excellency the President launched the abolition of fees for health care for  Pregnant women,  lactating mothers  children under 5 The BPEHS constitutes the minimum set of services but ALL other services in addition to the BPEHS are delivered free of cost to the target population.

6. Defining the Needs  Brainstorm and ask: Why do health facility staff charge for services? What will be the result if fees were removed? Which resources are needed to be put in place to prevent the ugly incidents? How to mobilise the needed resources Issues of Quality control Issues of Sustainability

7. Ingredients for FHSD Surveillance Support SustainabilityQuality Control Staff Structure Supplies Supervision

8. Which services free, and for whom? From 27 th April 2010, all health services provided at government facilities is now free of charge for pregnant women, lactating mothers and children under 5 years. Note that services already provided free of charge (including HIV/AIDS, TB and Leprosy) will continue to be free for everybody.

9. Presidential Reports - Progress reports sent to the Vice President’s Office on progress and areas of risk to successful implementation with key actions which need to take place. Copies of report also sent to Ministry of Finance. Steering Committee - attended by MoHS heads of subcommittees and other representatives from subcommittees. Makes key decisions on design and implementation and reviews progress against timeline and updates from sub committees. Monitoring and Evaluation Finance Strategy, Vision and Governance (Steering Group Meeting) Human Resource CommunicationsLogistics/Drugs Service Delivery Plan Tracker Tool Subcommittees Steering Committees Gantt Chart/Project Timeline Infrastructure Governance Structure for FHCI

10. Trends In Utilisation of Services in 6 Health Facilities in Western Area

12. Challenges Sustained Increase in demand for services at health facilities Delay in arrival and distribution of drugs and other logistics Theft of drugs Shortfalls in staff supply (no. in payroll =7,767) Integration of faith-based organisations & other health care deliverers into the FHCI Total funding gap of US$ 8.5 Mlln

13. Future Plans Drugs sub-committee to look at longer term measures for procurement and supply chain management system Communications sub-committee to look at clarification of messages meant for community level Improvement of management systems to ensure a clean payroll Integration of faith-based and other organisations into the scheme Set up a monitoring system (monitoring task force) of tracking progress.

14. The End