MSF’s experience in Sierra Leone has shown that patient fees act as a major obstacle to getting healthcare and lives that could be saved are lost every day. Necessary steps need to be taken now to improve the access to healthcare of the people in need in this desperately poor country.
Sierra Leone consistently ranks among the lowest in the world on the Human Development Index, having recently moved from last place (182) to 180. The maternal death rate and the child mortality rate in the country are the highest in the worldwith one in five children dying before their first birthday. Poverty is extreme, with more than half of the population living on less than a dollar a day.
An MSF doctor treats a child suffering skin disease in MSF Gondama hospital in Bo, Sierra Leone. May 2008
Photo by William Daniels
MSF’s experience of working in Sierra Leone has shown that moving to a system of free care produced a sudden and dramatic increase in the number of patients seeking help, even if the fees requested were low. Nevertheless, in Sierra Leone all patients are required to pay when seeking treatment in the national health system. A simple consultation may cost as much as the equivalent of 25 days of income.
Seco Gerard, MSF advocacy advisor, said: “The health situation in Sierra Leone is in a state of emergency, with people dying every day because they can't get treatment. Asking people to pay for healthcare in such a context has devastating consequences as many simply cannot afford the fees. For example, people wait to seek treatment until their health situation has becoming critical, or buy poor quality medicine in the local market. Many do not even seek help at all.”
New national policy on free care
On 18th and 19th November the Sierra Leone Investment and Donor Conference will be held in London, which will bring together representatives from the Sierra Leone government and international donors. The purpose of the conference is to establish a broader base of donor support for Sierra Leone. At the conference, the Government of Sierra Leone will launch a plan for a fair healthcare financing mechanism which includes the abolition of user fees for women and children.
Seco Gerard said: “The Sierra Leone government has publicly stated its commitment to abolish user fees and the UK government and other donors have promised to help. What is crucial now is that Sierra Leone actually receives the necessary funding and technical assistance to realise this objective. It is time that words are being followed up by concrete action. If not, people who could otherwise be saved will continue to die needlessly every day.”
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MSF has worked in Sierra Leone since 1986. MSF supports a referral hospital near Bo, the country’s second largest city, and supports the operation of 30 rural health posts. MSF offers in-patient services for women and children, malaria treatment, as well as a therapeutic feeding programme. In total, over 417,000 consultations were carried out during 2008.