While familiarising himself with the situation on the ground, Eni has discovered several problems as he tells us in this revealing interview:
Why are you in Sierra Leone?
I am in Sierra Leone as an Advisor/Consultant to assist in building the health services planning and management capacity of senior staff of the Ministry of Health & Sanitation especially in Bo Health District.
How did you get this assignment?
In 2007, prior to my going to Nigeria at the invitation of the National Universities Commission, I promised my friend the late Dr. Perinbaum, Board Chair of the Commonwealth of Learning Agency and first Executive Director of CUSO that I will focus my professional contribution in Africa following my retirement. CUSO-VSO Canada provided me with the opportunity to fulfill my promise as Dr. Perinbaum died when I was still in Nigeria in 2008 as a Visiting Professor at the University of Nigeria. CUSO Canada has joined the U.K. based VSO to form an international consortium of volunteers. Moreover, some of my high school teachers in Nigeria were educated at Fourah Bay College in Sierra Leone. Therefore it was very easy for me to make the choice to go to Sierra Leone after reading CUSO-VSO Sierra Leone Health Program Area Plan for the country, especially following the devastating effects of civil war.
I did not have to go anywhere after spending the last fifteen years consulting in Africa, South-East Asia, and Easter Europe. Somehow, I had a strong feeling about fulfilling my promise to Dr. Perinbaum. I spoke to a few people at CUSO Canada and read extensively about Sierra Leone before making up my mind to assist. I became aware of the valuable charitable work CUSO-VSO is doing internationally as it was my first and only connection with an NGO in a consultative role. My previous work had been with governments and international multilateral organizations. I had to accept the invitation to go to Sierra Leone for six months rather than for one year as requested.
What are you doing currently?
I spent my first month in Sierra Leone understanding the country’s health care infrastructure, organization, and delivery system. I also travelled to various Community Health Units and Centers in Chiefdoms within the Bo Health District to learn about their field operations. To gain better insight into multiple international efforts, I visited and interviewed several Non-Governmental Organizations working in health care including senior health care management employees of the Ministry of Health and Sanitation. I also interviewed City and Community Councillors to whom the responsibility for health services has been devolved. This enabled me to formulate need-based assistance to individual departments and/or operations. I currently spend time with department heads, managers, and program coordinators. Given the enormous planning and management challenges faced by the system, I have given two public presentations on health services planning and management which was attended by NGO representatives, Ministry officials, some religious groups, Councillors, and program coordinators among others.
I am currently providing individualized management assistance to departments. One of VSO Sierra Leone’s goals is to strengthen the coordination and management capacity of District Health Management Teams as a way of strengthening the broader health management systems and policy implementation capacity for improved primary health care services, focusing on Maternal and Child Health. I intend to produce a report for the Ministry as well as a publishable review of the healthcare challenges in Bo District of Sierra Leone, hopefully to inform donors about other opportunities for assistance.
What is your immediate appraisal of the health needs of Sierra Leone?
Needless to say that Sierra Leone is located at the bottom of several health status indicators among nations with the worst infant and maternal mortality rates. There is grinding poverty especially after the civil war. In a nutshell, Sierra Leone needs many health workers – doctors, nurses, paramedicals, and every category of health occupation. Several indigenous doctors, specialists, and nurses fled the country during the civil war never to return! Some District hospitals have only one doctor and perhaps one or two other itinerant doctors. Community Health Officers are being trained in large numbers to fulfill some of the responsibilities of physicians in hospitals and Peripheral Community Health Units. This may pose some professional boundary challenges in future. State Enrolled Community Health Nurses and Community Health Aides are also being trained to work in Community Heath Posts and Centres along with volunteers. There is grave shortage of medicines and equipment. Wages for health workers are very low.
However, there are several positive outlooks for health care in Sierra Leone. In spite of the lack of resources, the government is working hard to organize a system that is responsive to communities through decentralization, strategic planning and devolution of accountability to Chiefdoms, city and community councils. Decentralization seems to have occurred political but not technically. Also many international organizations such as UNICEF, WHO and several NGOs are helping with drug supply, medical centers, transportation, some ambulance services, and motorcycles for funded community programs. Some of these efforts are uncoordinated as some NGO pick and choose where to operate, what to do, and how to do it based on their mandate and bureaucracy. Recently, some NGO activities are beginning to be coordinated with some government services, but not nearly enough. There is some form of dependency culture being propagated in some areas. NGOs are also assisting with national campaigns such as mosquito net distribution, vaccinations, and immunization of children. I had the rare opportunity of meeting the Country’s First lady during a recent pneumococcal immunization Lunching Campaign in Bo City.
The World Bank also recently lunched the second phase of the Maternal and Child Health grant funding albeit with severe fiscal management controls. Last year, the government mandated free health care for lactating women and children less than five years of age. Overall, there is some progress but not rapidly enough. I am impressed with the commitment of health workers in Bo District given low emolument and shortage of equipment. I hope many retired health care professionals will volunteer their services in Sierra Leoneas the country rebuilds its health care system following the civil war. In particular, I hope that Sierra Leoneans in diaspora will also return to make their contribution.