Quality of care in Sierra Leone

The Problem

Sierra Leone is one of the most dangerous countries in the world for mums, babies and children.



An estimated one in 17 women in Sierra Leone will die as a result of pregnancy or childbirth (compared with one in 5,800 in the UK). This West African country has the highest rate of maternal mortality in the world - and the 4th highest rate of child mortality.

Some of the biggest problems lie in the country’s health system, which is critically underdeveloped, understaffed and under-funded. This means the care that people receive from the health service is often poor and ineffective.

Thanks to the work of development organisations, the situation has been improving in recent years, with more local health volunteers and equipment. However, provision is still poor. For example:

  • Health services have chronic low levels of staff. In community health centres, approximately a third of posts are unfilled (either due to lack of funds or lack of qualified personnel), a third are voluntary, and just a third are employed
  • Salaries for employed staff are low and sometimes not paid at all. This leads to high levels of demand for ‘under-the-counter’ payments which exacerbate poverty and disadvantage the poorest members of society
  • Supplies of essential drugs and equipment often run out – leading to mothers and families having to buy from private shops locally, not get treatment, or travel to another facility
  • Many health facilities do not have secure power and some have no water or sanitation
  • The quality of data, reporting and surveillance is variable and often incomplete
  • Preventive health services and health promotion are limited and not always coordinated

This lack of reliable health care deters poor families from seeking care and perpetuates continued belief and use of traditional practices. (Some of these practices may be helpful - but some also harmful.)

Goals

Much of the excellent work conducted by organisations in Sierra Leone has aimed to improve the provision of health services. Child.org and the World Health Organisation (WHO) have started working together because we believe that there are missed opportunities to improve the quality of care.

What is quality of care?

Quality of care is about what actually happens when a person accesses a health service. Were they treated with dignity and given privacy? Were they treated with kindness and afforded equity? Was the person treating them provided with the right information, and did they pass this information on to the patient?

Changes to quality of care are less reliant on ongoing funding than changes to provision (which might involve hiring more staff or providing more equipment.) But quality of care can have a big impact. If we can make people’s experiences of accessing healthcare more positive, they will be more likely to seek help again, and they will be more likely to receive and pass on vital health information.


In Sierra Leone
1 in 17 women
will die as a result of pregnancy or childbirth

Evidence

 

Who defines quality of care and how do we measure it?

The term "quality of care" is defined by the World Health Organisation (WHO), and they also provide a framework for improving the quality of care for mothers and newborns. Sierra Leone has recently joined the international Quality of Care Network, but at the moment it has no data or basic tools to provide consistent evidence about the experience of health service users.

Without this evidence, Sierra Leone can't identify where low or zero-cost improvements in quality and experience may be possible. It's also impossible for local health services, government or WHO to monitor improvements.

This is why Child.org are keen to prioritise the development of these data and tools - as you'll see from the methodology outlined below.

The proportion of births in developing countries attended by skilled health personnel
up from 56% to 68%
between 1990 and 2012
Globally
99% of maternal deaths
occur in developing countries

Evidence based on:

Standards for improving quality of maternal and newborn care in health facilities (WHO) Read article
The Master Plan from Child.org (outlining our programming approach) Read article

Where we work

Child.org are working with the Department of Public Health at the University of Makeni. 

We are proposing our first health needs assessment to run in the population served by Yoni Community Health Post. This is close to one of the university's outlying campus buildings, allowing for us to start the project together with fewer start-up logistics and costs. 

Yoni Community Health Post covers a population of 3,144 people spread across nine rural villages on the outskirts of Makeni. These villages were disproportionately affected by Ebola - in one village over 50 people were killed.

 

Methodology

Child.org’s work in Sierra Leone is about investigating to find clever little, inexpensive changes that will have a big impact. As the data and assessment of care in Sierra Leone is scant - our first move is to collect this information to help us to identify the biggest opportunities to improve quality of care.

1. Assessment tools

We will develop simple tools to assess the experience of using health services by mothers, families of newborns, children and adolescents in Sierra Leone. 

The assessment tools we develop will be based on existing tools used across a range of diverse countries.  They will help collect data linked to key indicators and international rights-based standards.

The data sets and tools we create can then be used by WHO and Government of Sierra Leone to drive improvement priorities and reporting indicators. They will also be used by district and local health services in Bombali and Makeni (plus Child.org and other partners) to identify and inform further interventions.

2. Improving quality of care and encouraging access

Child.org, and the organisations we are working with, will use the information gathered to act on opportunities to improve the quality of care for mothers, babies and children. We are investigating ways to help people to identify when they need to seek healthcare, and encouraging them to do so.

For example, we are proposing a pilot study to identify pre-term and underweight babies born at home using a simple foot measurement card.

How you can help

Child.org's work in Sierra Leone is in its infancy.

If you're interested in supporting an important and innovative stream of international development programming, right from the very beginning, please consider joining making a donation, and make sure you check the box to receive our newsletter. We'll update you as things develop!

 

Note: The photographs we're currently using to illustrate our work in Sierra Leone on this website were actually taken in Kenya on our other programmes. We have not yet had the opportunity to photograph our new work in this country, but we hope to have some photographs from Sierra Leone soon!