Quality of care in Sierra Leone

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.)

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.