Sierra Leone's government launched a major initiative on April 27 to make health care free for pregnant women and children, and I'm just back from a trip to Freetown, Sierra Leone's capital, to find out more about it. The program abolished fees at public hospitals and health clinics across the country for a set of basic health services for all pregnant and nursing mothers, and for every child under five years old.
The new initiative has attracted a steady trickle of international journalists to Freetown, which is tentatively emerging from 14 years of a brutal, traumatizing civil war for control of the country's lucrative diamond fields. As a result, Sierra Leone is one of the poorest countries in the world – over 70 percent of the population lives in poverty, and it has some of the highest rates of maternal and child death in the world.
Given the very high levels of poverty, it is not surprising that two years ago a government survey found that 88 percent of those polled said the fees charged for health services were the primary reason that they didn't make doctors visits. Sierra Leone's President, Ernest Bai Koroma, responded by announcing plans for the initiative almost a year ago.
Since then, the staff at Sierra Leone's Ministry of Health and Sanitation have struggled intensely behind the scenes to make the dramatic changes needed to the public health system for free health care to become a reality.
Putting ideas into practice
I made a visit to one of the key figures behind the initiative – the director of the ministry's reproductive and child health program, Dr. Samuel A.S. Kargbo. He is widely known by his nickname, “Sass.” Before working at the ministry in Freetown, he spent ten years working as a district medical officer in two remote districts, one in the north of the country. He later volunteered to be a district medical officer in another second remote district, Kailhum, in the south east of the country, which was behind rebel lines during most of the war. Although his specialty is gynecology, he explained to me the rebels tolerated his presence because he was able to perform hernia and other types of surgery that they couldn't obtain otherwise.
I asked Kargbo what has inspired him to stay in the country when so many of his colleagues have left. Sierra Leone, like other African countries, is experiencing a dire shortage of medical workers. He smiled and told me that he trained at Leeds University in public health. “At school they would give us an assignment, for example, ‘Write a plan to cut down on maternal mortality',” Kargbo said. “I handed them in, and when I got back to Sierra Leone I remembered them and found that as a district medical officer I was able to put ideas I had as a student into practice. And when I did, I really could see the results. And to this day, that's what keeps me doing this work – seeing the results.”