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Healthcare in Sierra Leone
Total population (2016) – 7,396,000
Gross national income per capita (PPP international $, 2013) – 1,750
Life expectancy at birth male/female (years, 2016) – 52/54
Probability of dying under five (per 1 000 live births, 2018) – 105
Probability of dying between 15 and 60 years m/f (per 1 000 population, 2016) – 394/383
Total expenditure on health per capita (Intl $, 2014) – 224
Total expenditure on health as % of GDP (2014) – 11.1
The Sierra Leone health care system is organised into two tiers of care: Peripheral Healthcare Units (PHUs) with an extended community health programme and secondary care which includes 21 district and three referral hospitals; there are also 45 private clinics and 27 private hospitals, mostly in the Freetown area.
The PHUs are designed to be the delivery point for primary health care in the country and there are three main types.
The community health centre carries out health prevention measures, cures and health promotion activities and is in charge of overseeing the other PHUs in the area. It is planned that each chiefdom area, the unit of local government in Sierra Leone below the level of district, should have at least one community health centre.
Community health posts perform a similar function to community health centres but have fewer facilities and are used to refer patients to the health centre or the district hospital.
Maternal and Child Health posts are the first level of contact on the ground and are located in smaller towns of with populations between 500-2000. Much of the health care infrastructure was decimated during the Civil War and the health service is still in the process of being organised with hospitals and PHU being rebuilt or created and staff being trained.
On the health-related impact indicators, Sierra Leone ranks worst for life expectancy at 51 years, and maternal mortality at 1,360 maternal deaths per 100,000 live births. Whilst this figure is only one estimate, the next best estimate from the DHS 2013 survey of 1,165 maternal deaths per 100,000 live births would still place Sierra Leone at the bottom of this list.
On child mortality, Sierra Leone ranks 2nd from the bottom on infant mortality in 2016 with the most recent estimate showing 87 deaths in the first year of life per 1,000 live births, and 4th from the bottom on under-5 mortality with 120 deaths per 1,000 live births. The same question as for maternal mortality must be asked: what is the missing link between high coverage of child health interventions and the high mortality. Taking a more holistic and integrated view of child health outcomes in relation to nutrition, WASH and environmental health, and malaria programming amongst other areas will be key to reducing child mortality in years to come.
The adolescent fertility rate, which shows the number of births per 1,000 women, has also been constantly improving, and Sierra Leone ranks 9th from bottom on this indicator. Further improvements, driven by multi-sectoral action, will contribute to driving down maternal mortality as well as improving the quality of life for young women in Sierra Leone. Likewise, the total fertility rate is falling, and this is the only impact indicator where Sierra Leone is in the top half of performers.
For more information: www.mohs.gov.sl