Sierra Leone’s maternal health reforms fail to deliver free treatment, says Amnesty International

BMJ 2011; 343 doi: (Published 07 September 2011) Cite this as: BMJ 2011;343:d5645
  1. Peter Moszynski
  1. 1London

Sierra Leone’s recent health reforms risk being undermined by serious weaknesses in the health system that often result in pregnant women being unable to get free treatment, says a new report by Amnesty International.

Despite important reforms begun over the past two years, including a free healthcare policy covering pregnancy and childbirth, the report warns that “the healthcare system is dysfunctional and much remains to be done.”

Health facilities are “often short of essential drugs and supplies,” says the report. “Disparities persist between rural and urban areas, the quality of care is frequently substandard, and overwhelmingly women still have to pay for essential drugs.”

The launch of the free healthcare initiative in April 2010 “gave the promise of care and safe delivery to women and girls, and positive progress has been recorded,” it adds. Government figures show that the proportion of deliveries occurring in healthcare facilities rose by 45%—from 87 302 to 126 477—in the past year.

However, the report maintains that for many women and girls “the promise of the free healthcare has not been fulfilled.” In interviews, numerous women who had tried to use the healthcare system after the launch of the initiative told Amnesty that they were unable to access drugs or care.

Interviewees reported two main problems with the initiative: “Either drugs and other essential medical supplies are simply not available at the health facilities, or they are charged for medicines and care that are supposed to be provided for free.”

Often, when essential drugs for women in pregnancy and childbirth are not available for free, they are available for a price, in the same facility, as “cost recovery” drugs.

Erwin van der Borght, Amnesty International’s Africa programme director, said, “The healthcare system remains dysfunctional in many respects. Government figures show that since the introduction of the initiative more women are accessing antenatal care and delivering their babies in health facilities.

“However, many women continue to pay for essential drugs, despite the free healthcare policy, and women and girls living in poverty continue to have limited access to essential care in pregnancy and childbirth.”

He said that a “critical shortcoming” within the healthcare system is the “absence of any effective monitoring and accountability systems, without which reforms cannot succeed.”

His organisation maintains that effective monitoring and accountability are “vital to the realisation of the right to health” and are the “basis for promoting changes which allow women and girls to enjoy their right to maternal health and give birth more safely.”

Amnesty welcomed the “positive response” to the report from Sierra Leone’s health ministry but insists that “planned reforms must be translated into action.”


Cite this as: BMJ 2011;343:d5645


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