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Congratulations Sierra Leone

His Excellency Ernest Bai Koroma, President of the Republic of Sierra Leone, announced on 5 November the abolition of health user fees, with effect from 27 April, 2010.

The announcement was welcomed by a hall packed with government officials, donors, development partners, and implementing agencies that had gathered for the launch of the first national health sector strategic plan.

Detractors may be ready to say that, despite the announcements and promises, things will remain the same for children and women in Sierra Leone. But what makes a difference this time is that Sierra Leone has a plan and is committed to implementing it.

The impact of user fees on the use of the health service and, ultimately, on people’s health is clearly demonstrated by the very high maternal and child mortality rates.

The Government of Sierra Leone first appointed a technical working group to define a strategy. They aimed to identify and increase critical functions within the health system to ensure that once user fees are abolished the health system can deliver services and that user fees are not replaced by other unofficial charges.

What sounds like a pretty simple concept will require increased funding for the health sector and substantial improvements to human resources, deployment, retention, development and performance management.

In addition, an efficient drugs and equipment procurement and supply chain management system is needed. And a clear public information campaign would not only encourage people to exercise their right to healthcare, but also ensure health providers understand their role and responsibility in implementing the policy changes.

All of these components must be framed by an efficient monitoring and evaluation system for stronger management performance.

The strategy will be presented next week at the Sierra Leone Donor Conference (November 18-19 2009 in London), which I will be attending. We will show a film produced by Save the Children, in collaboration with the Government of Sierra Leone. The film is a form of policy dialogue and illustrates the steps required to abolish user fees and provide free health care at the point of access. It does so, through the words and faces of children and mothers, health providers, and ultimately the President of Sierra Leone.

Save the Children expresses heartfelt congratulations to the Government of Sierra Leone for embracing the free health care agenda – an essential short-term solution, while medium and longer term plans, focusing on social health insurance, are being made.

A commitment to increase the share of national budget allocation to the health sector to 15% is a milestone step.

Now we trust the donor community will make available the necessary resources to bridge the funding gap and build technical capacity to ultimately materialise the agenda.

This is a turning point for the health sector in Sierra Leone, in its pursuit to care for the lives of mothers and children. Now is the time to act to make a real difference and save lives. It is the time for the donor community to seize this opportunity with both hands.

Find out more

Read our briefing, which looks at the barriers that poor families face to getting basic healthcare, and how these can be overcome.

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