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Inadequate personnel & structures Engulf Pujehun Public Health Units

By Mohamed Konneh

Public Health Units (PHUs) in the Southern district of Pujehun remains deplorable with most of the Units having poor and dilapidated structures, inadequate medical supplies as well as personnel. The district is seriously challenged when it comes to health service delivery in the country.

PHU at Taninehun in Pujehun district with CSO Swaray pointing at the facility

A visit to the district and reaching out to the PHUs last week explains the need for government to pay more attention to the district health care service. Public Health Units remains the only facilities that attend to community sick people especially pregnant women, lactating mothers and children under the ages of five.  Sierra Leoneans in most remote parts of the country are still suffering as a result poor and inadequate health delivery systems.

In Taninahun, Kpanga Kagbo Chiefdom, in the Pujehun district is the only health unit that attends to patients remains an old mud house offered to the District Health Medical Team to be used by nurses that attends to patient.

The In-Charge at Taninehun Baindu Smith explained the constraints they go through in terms of delivery health care service to the people.

“This is the only PHU that serves four villages in this area and that drugs brought sometimes only last for about three months. Storage is a problem here as you can see this is just an ordinary mud house offered to us by the community. This is not a befitting facility for health service delivery, she said.

Baindu Smith is the only Maternal Child Health aid in the facility and has been working at the facility for the last three years.

As you can see when there is a meeting in Pujehun town there is no body to stay behind and who so ever that is sick will have to wait till I return. Sometimes the work load is too much and I am human I get tired. There is every need for another MCH aid to be posted here otherwise the situation will remains the same.

Baindu say she is doing her best but a single hand cannot handle all the cases that reach the centre. This is a difficult place to work but I am a native of this area and the reason why I continue to serve my people, she said.

Imrana Kamara the village Development Committee chairman in Taninehun expresses concern over the health facility currently been utilized by the community saying “this is not a health centre”.

Taninehun in Pujehun district is the not the only PHU suffering from poor facility and inadequate drug supplies. Similar story if not worse exits in Sowa Chiefdom in the Pujehun district.

Here at this PHU, the nurse in Charge Salamatu Turay says drugs supplies last only for few weeks and months. Sometimes the facility goes for months without drug supplies and this is the reason why we have now adopted a common understanding with the community to be buying drugs when government supplies finishes. It is a difficult situation but this is what we are going through at the moment.

Madam Turay said they’ve reached an agreement with stakeholders in the chiefdom for the purchase of drugs that will be sold to community people when drugs supplies to the facility are not available.

Community effort in Taninehun, PHU under construction

In the case on Taninehun Madam Turay is the only MCH aid in this facility and does all the work.

Sowa chiefdom in the Pujehun district is among some of the largest chiefdoms in the district. The facility serving as health unit is also in deplorable condition with no proper structure to store drugs.          Background

The Data Envelopment Analysis (DEA) method has been fruitfully used in many countries in Asia, Europe and North America to shed light on the efficiency of health facilities and programmes. There is, however, a dearth of such studies in countries in sub-Saharan Africa. Since hospitals and health centres are important instruments in the efforts to scale up pro-poor cost-effective interventions aimed at achieving the United Nations Millennium Development Goals, decision-makers need to ensure that these health facilities provide efficient services. The objective of this study was to measure the technical efficiency (TE) and scale efficiency (SE) of a sample of public peripheral health units (PHUs) in Sierra Leone.

Methods

This study applied the Data Envelopment Analysis approach to investigate the TE and SE among a sample of 37 PHUs in Sierra Leone.

Results

Twenty-two (59%) of the 37 health units analysed were found to be technically inefficient, with an average score of 63% (standard deviation = 18%). On the other hand, 24 (65%) health units were found to be scale inefficient, with an average scale efficiency score of 72% (standard deviation = 17%).

Conclusion

It is concluded that with the existing high levels of pure technical and scale inefficiency, scaling up of interventions to achieve both global and regional targets such as the MDG and Abuja health targets becomes far-fetched. In a country with per capita expenditure on health of about US$7, and with only 30% of its population having access to health services, it is demonstrated that efficiency savings can significantly augment the government’s initiatives to cater for the unmet health care needs of the population. Therefore, we strongly recommend that Sierra Leone and all other countries in the Region should institutionalise health facility efficiency monitoring at the Ministry of Health headquarter (MoH/HQ) and at each health district headquarter.

“Public health is the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort, according Moses Rogers from the DHMT who accompanied the teams during the exercise.” 

He said supplies of drugs and other medical reagents remains some of the difficult challenges for the district. This is something we have been grappling with since 2017 but we hope it will change now that we have a new administration in charge.

Sierra Leone with a population of 7 million people continues to face challenges in the health sector. The country’s total fertility rate is around 6.5 and its health indicators are poor. For example, life expectancy at birth is 34.2 years; the probability of dying (per 1000 live births) before the age of 5 years is 313 and between 15 and 59 years is 619 according to the Health performance report 2013. The number of maternal deaths per 100000 live births is 2000. These dismal health indicators are a reflection of poor governance, poor macroeconomic performance and poor national health system performance.

The total expenditure on health as a percentage of the gross domestic product (GDP) increased from 2.6% in 1996 to 4.3% in 2000 and from 4.3% in 2001 to 7.5 in 2013. General government expenditure on health constituted 60% of the total expenditure on health; the remaining 40% came from private households and out-of-pocket spending. The fact that health indicators had continued to decline in spite of health expenditure increases could be partly due to an inefficient public health system.

Peripheral health units (PHUs) are a vital part of Sierra Leone’s public health system. Given their strategic location in the midst of communities, they constitute an invaluable vehicle for ‘organizing community effort for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene and the organization of medical and nursing services for the early diagnosis and preventive treatment of disease’. PHUs are instrumental in efforts to scale up pro-poor package of cost-effective interventions aimed at achieving the Sustainable Development Goals (SDGs).

Therefore, decision-makers especially the Ministry of Health and Sanitation need to ensure that PHUs provide services efficiently.

The visit to twenty PHUs in the Pujehun district was to measure the scale of efficiency among a sample of public PHUs in the country bringing out some of the difficulties challenges faced by the facility management.  The result and publication of this visit could be used in the pursuit of the public health objective of promoting efficiency in health facilities.

Overview of Sierra Leone health care delivery system

The Ministry of Health and Sanitation (MOHS) provides about 50% of health care services. The remainder is provided by the private sector (private-for-profit institutions and traditional healers) and national (e.g. Christian Health Association of Sierra Leone) and international (e.g. German Leprosy Rehabilitation Association and Medecins Sans Frontieres) NGOs.

The country has 14 health districts, each with a District Health Management Team responsible for the implementation, supervision and monitoring of health programmes in the district. Sierra Leone has a total of 31 government hospitals, 22 mission hospitals/clinics, 78 private hospitals/clinics and a network of 1,136 PHUs.

Malaria still remains the common sickness affecting people throughout the twelve chiefdoms in the Pujehun district. However, maternal mortality has reduced with just 11 recorded cases of maternal mortality in 2018.

However, in the Pegewa Health centre the building under construction is almost completed under the Christian Aid Health Legacy project implemented by the Budget Advocacy Network and RADA.

The Pujehun District Council Chief Administrator, Edward Alpha in response to the deplorable health delivery service facilities in the district said, since 2017 only 25% budget allocation came to the council. This fund was basically used for council administration and not much of service delivery.

He said funds for projects never came in during 2017 making the council to do little or nothing. We are yet to receive funding for this year also but we believe things will get back now that the elections are over and a new administration in place.

Newly constructed PHU nurses quarters in Pegawa

“This is the situation we have been grappling with all this while and this affect much of our work for the year 2017. But we thank God because we have organizations support the Health sector. As you can see rehabilitation is currently taking place on some of our PHUs while some will be constructed, the Chief Administrator said.

The Health legacy project funded by Christian Aid will rehabilitate and construct twenty PHUs in the district while the council will also do similar activities in other areas during this new financial year, he said.

This exercise undertaken reveals the difficulties and challenges of the country health care delivery in Pujehun district one of Sierra Leone deprived districts in the country.

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