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Sierra Leone demands improvements in maternal health Sierra Leone demands improvements in maternal health
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Local communities in Sierra Leone are being encouraged to rate their clinics and demand more from their healthcare services in a bid to cut the country's high maternal mortality rates.Local communities in Sierra Leone are being encouraged to rate their clinics and demand more from their healthcare services in a bid to cut the country's high maternal mortality rates.
The riskiest thing a woman can do in Sierra Leone is get pregnant; one in every 21 women is at risk of death in child birth. Maternal death rates are falling, but an initiative to speed up progress has just been launched with the backing of the UK's Department for International Development.The riskiest thing a woman can do in Sierra Leone is get pregnant; one in every 21 women is at risk of death in child birth. Maternal death rates are falling, but an initiative to speed up progress has just been launched with the backing of the UK's Department for International Development.
The thrust of the campaign is to empower local communities to force healthcare up the political agenda by giving them the evidence they need to fuel arguments for higher standards.The thrust of the campaign is to empower local communities to force healthcare up the political agenda by giving them the evidence they need to fuel arguments for higher standards.
Evidence 4 Action (E4A), a programme led by Freetown obstetrician Dr Mohamed Yilla, is based on the belief that rapid progress is possible, and maternal and baby mortality can be dealt with if everyone chooses to act.Evidence 4 Action (E4A), a programme led by Freetown obstetrician Dr Mohamed Yilla, is based on the belief that rapid progress is possible, and maternal and baby mortality can be dealt with if everyone chooses to act.
"The issue of babies and maternal health should no longer just be a government issue; it should be of community interest," says Yilla. "The community can bring about the sustainable health system and maintain it.""The issue of babies and maternal health should no longer just be a government issue; it should be of community interest," says Yilla. "The community can bring about the sustainable health system and maintain it."
A native of Sierra Leone, Yilla studied and practised medicine in Aberdeen before returning home to work with E4A, a programme being run in six sub-Saharan countries over five years.A native of Sierra Leone, Yilla studied and practised medicine in Aberdeen before returning home to work with E4A, a programme being run in six sub-Saharan countries over five years.
"As a general rule 15% of births will have complications, but in the UK you are in an environment where everything is there to save a woman's life," he says. "You turn the page and go 6,000 miles south, and women enjoy the same pleasure of being pregnant but are facing something that carries a risk of death.""As a general rule 15% of births will have complications, but in the UK you are in an environment where everything is there to save a woman's life," he says. "You turn the page and go 6,000 miles south, and women enjoy the same pleasure of being pregnant but are facing something that carries a risk of death."
The MamaYe! campaign is an E4A advocacy programme for safer maternal clinics. It evolved in response to a sense that not enough progress was being made to meet the millennium development goals on reducing child mortality and improving maternal health.The MamaYe! campaign is an E4A advocacy programme for safer maternal clinics. It evolved in response to a sense that not enough progress was being made to meet the millennium development goals on reducing child mortality and improving maternal health.
The first step on the E4A programme was to bed down a system of data collection in conjunction with the government, establishing which clinics across the country had the basics and which didn't. "It's a very basic checklist: electricity, running water and blood supply. These are things that … save women's lives," says Yilla.The first step on the E4A programme was to bed down a system of data collection in conjunction with the government, establishing which clinics across the country had the basics and which didn't. "It's a very basic checklist: electricity, running water and blood supply. These are things that … save women's lives," says Yilla.
The health ministry already has a reporting structure, set up by the UK consultancy Options in 2012. With the help of E4A, it is running quarterly surveys of clinics; data is shared with all stakeholders in the country's health system, including politicians, community chiefs, aid agencies and NGOs.The health ministry already has a reporting structure, set up by the UK consultancy Options in 2012. With the help of E4A, it is running quarterly surveys of clinics; data is shared with all stakeholders in the country's health system, including politicians, community chiefs, aid agencies and NGOs.
"The real power lies in … invoking the response in people to demand more from their health service. Often there is a feeling if someone dies it's God's will. There is a cultural fatalism," says Yilla."The real power lies in … invoking the response in people to demand more from their health service. Often there is a feeling if someone dies it's God's will. There is a cultural fatalism," says Yilla.
E4A aims to shift that thinking through evidence-based advocacy. It can claim some success in last year's election, when it distributed 5,000 score cards to communities, rating clinics up and down the country.E4A aims to shift that thinking through evidence-based advocacy. It can claim some success in last year's election, when it distributed 5,000 score cards to communities, rating clinics up and down the country.
"People could see, for example, that a region in the south of the country is the least populated but the most well-funded of the lot. They started to ask questions and demand more," says Yilla."People could see, for example, that a region in the south of the country is the least populated but the most well-funded of the lot. They started to ask questions and demand more," says Yilla.
The data was collated from government sources as part of a budget-tracking programme run by E4A in line with the goal of increasing health spending to 15% of the country's annual budget. This target is in line with a pledge made by African heads of state back in 2001, under the Abuja declaration (pdf). Before the general election in November 2012, Sierra Leone's health spend was 7.5%; after the election, it increased to 10.5%. Coincidence?The data was collated from government sources as part of a budget-tracking programme run by E4A in line with the goal of increasing health spending to 15% of the country's annual budget. This target is in line with a pledge made by African heads of state back in 2001, under the Abuja declaration (pdf). Before the general election in November 2012, Sierra Leone's health spend was 7.5%; after the election, it increased to 10.5%. Coincidence?
"Attribution is always difficult, but this advocacy work showed we were way below the budget target and contributed to that increase," says Yilla."Attribution is always difficult, but this advocacy work showed we were way below the budget target and contributed to that increase," says Yilla.
It is estimated that 26% of maternal deaths in sub-Saharan Africa are a result of haemorrhaging – and Sierra Leone collects only a quarter of the blood it needs annually for transfusions.It is estimated that 26% of maternal deaths in sub-Saharan Africa are a result of haemorrhaging – and Sierra Leone collects only a quarter of the blood it needs annually for transfusions.
Part of the advocacy programme is designed to shift thinking about donating blood. To this end, 30 journalists are being trained to improve reporting on the issue and get the message out to men and women that their families' survival could be helped through blood donation.Part of the advocacy programme is designed to shift thinking about donating blood. To this end, 30 journalists are being trained to improve reporting on the issue and get the message out to men and women that their families' survival could be helped through blood donation.
"Making sure through evidence and advocacy that people have confidence that their clinic is safe, and making sure the communities and government spend enough, that's what we aim to do," says Yilla."Making sure through evidence and advocacy that people have confidence that their clinic is safe, and making sure the communities and government spend enough, that's what we aim to do," says Yilla.
Sierra Leone sits near the bottom of the 186 countries in the UN's latest human development report (pdf), but it has huge prospects – and not because of aid. The mining industry is thriving again in the postwar environment and GDP has soared as a result of iron ore production, according to the African Economic Outlook.Sierra Leone sits near the bottom of the 186 countries in the UN's latest human development report (pdf), but it has huge prospects – and not because of aid. The mining industry is thriving again in the postwar environment and GDP has soared as a result of iron ore production, according to the African Economic Outlook.
"Sierra Leone is not going backwards. The windfall payments from the extraction industries have not peaked. Harnessing that windfall and making the investment in health should see major progress over the next two years," says Yilla."Sierra Leone is not going backwards. The windfall payments from the extraction industries have not peaked. Harnessing that windfall and making the investment in health should see major progress over the next two years," says Yilla.
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