Sierra Leone has the world’s highest child mortality rate. For every 100,000 live births in the west African nation, as many as 1,800 women die, according to UN Children’s Fund (UNICEF). And every year another half a million pregnant women die each year because they can’t access healthcare. Others have been imprisoned in clinics, because they cannot pay doctors' fees.The country’ s president announced in November that it is set to scrap maternal and child health user fees on Independence Day, April 27. But in a country with only about 170 doctors for more than five million people, minimal medical supplies and a health service recovering from 11 years of civil war, making the free service work will be a huge job. Getting rid of fees is a start, but critics are asking whether this really will be a cure-all for the country’s mums and children.
Health centres are few and far between in Sierra Leone, often far away from remote and poor communities. Besides user fees, poor people face other barriers to maternal healthcare such as transport costs and cost of being away from work. Fast decision making, better transport and quick treatment are more important in saving lives than free health care said a gynaecologist in the capital, Freetown. “At times, the husband - who has to decide - is not there,” he told United Nations news service, IRIN. “Or maybe the mother will say: ‘No, let’s wait. Or maybe there is an old woman in the community who will say: ‘Wait, wait, wait’ until it is too late.”Traffic delays and frequent delays at clinics can also be the difference between life and death. “The patient… gets to the facility - no doctor, no nurse, no medicine, no blood and the patient has to wait until a doctor is called on duty.”
Not enough trained healthcare workers is often an excuse governments use to delay improving maternal health care, said Monir Islam, of the World Health Organisation. “If a woman makes it to the clinic, will there be trained midwives, an electricity generator? Unless there is a comprehensive overhaul and improvement of maternal health care, poor people will continue to get only poor options, whether user fees exist or not.”
By Hayley Jarvis for SOS Children