Page 1 of12Theresa, Evelyn and Kayima:The Journey of Three Modern Women of Sierra Leone Written for VSO by: Glenn Bede A. Benablo* Volunteer and Programme Adviser (VPA) VSO Bahaginan, Philippines __________ Background My trip to Sierra Leone in August 2010 was truly an eye- opener for me. It was my first ever trip into the vastness of Africa and it was my very first sight of a real image of poverty. I have never seen a country where beggars, slums, dirt roads, homeless children, hunger and sickness were simply visible everywhere. Coming from another developing country, I must say that poverty in this part of the world is just so overwhelming. As a health development professional myself, I can see that health in Sierra Leone, among other sectors, needs serious attention for equally very serious reasons. Per WHO estimates in 2005, the country has the highest maternal mortality rate in the world (2,100 per 100,000 1 ). The Sierra Leonean government claims though that this figure has dramatically reduced in 2010 as a result of the implementation of the free health care for mothers and children. The enormous shortage of human resources for the sector is very alarming. Magburuka City of Tongkolili 1 Maternal Mortality 2005, Estimates developed by WHO, UNFPA, UNICEF and the World Bank
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Sierra Leone's Maternal Health and Health Human Resource Situation, Glenn Benablo
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8/8/2019 Sierra Leone's Maternal Health and Health Human Resource Situation, Glenn Benablo
My trip to Sierra Leone in August 2010 was truly an eye-opener for me. It was my first ever trip
into the vastness of Africa and it was my very first sight of a real image of poverty. I have never
seen a country where beggars, slums, dirt roads, homeless children, hunger and sickness were
simply visible everywhere. Coming from another developing country, I must say that poverty inthis part of the world is just so overwhelming. As a health development professional myself, I
can see that health in Sierra Leone, among other
sectors, needs serious attention for equally very
serious reasons. Per WHO estimates in 2005, the
country has the highest maternal mortality rate in
the world (2,100 per 100,0001). The Sierra
Leonean government claims though that this
figure has dramatically reduced in 2010 as a
result of the implementation of the free healthcare for mothers and children. The enormous
shortage of human resources for the sector is
very alarming. Magburuka City of Tongkolili
1Maternal Mortality 2005, Estimates developed by WHO, UNFPA, UNICEF and the World Bank
8/8/2019 Sierra Leone's Maternal Health and Health Human Resource Situation, Glenn Benablo
district, for example, has only one doctor for the 14,915 population. Unbelievably, apart from
his exhausting duty as a physician, he is also serving as the administrator of a poorly-equipped
and inadequately-staffed government hospital. Did I mention that this hospital is the central
referral facility for the entire district with 365,465 people? One does not need to look up and
calculate – it is a simple mathematical ratio: 1 doctor for 365,465 people equals impossible.
Like many other developing countries, Sierra Leone’s health system suffers from poor if not lack
of equipment, low levels of quality care, inadequately-staffed health facilities, the presence of
health personnel with low levels of motivation, and acute differences in access to health
services between the rural and urban population.
Sierra Leone’s population is currently estimated at 6.4 million yet there are only 3 physicians,
95 midwives and 245 registered nurses2
serving the entire nation. This is just too big a gaping
hole in its health care delivery system. This is a complete opposite in the Philippines, also a
developing country, where there are surpluses of doctors and midwives and overflowing supplyof nurses. There are over 200,000 unemployed yet skilled nurses in the Philippines to date
3. I
wonder if VSO as an organization did see this as an opportunity for Sierra Leone. Well,
apparently I did. As someone who takes a lead role with VSO Bahaginan’s partnership with the
Philippine Nurses Association, I see the potential of linking the two countries for targeted
volunteer placement programme for young Filipino nurses.
Maternal Health
On April 27 th
of this year, the country celebrated its 49th
year of independence. Pregnant women, breastfeeding
mothers and children under the age of five received free
health care services from government hospitals and clinics
for the first time. This free health-care-for-all scheme is an
initiative of the government in line with its 5-year (2010 to
2015) national health sector strategic plan. The
introduction of free services is a bold step for a country
where cost is the biggest barrier to accessing health services.
Sierra Leoneans have on average, only visited health facilities less than once a year, because of
the fees. In 2008, only one-quarter of all births took place in a health facility and just 42% of
2Figures from Government of Sierra Leone, Ministry of Health and Sanitation, National Health Sector Strategic Plan
2010 to 20153 Figures from Philippine Nurses’ Association 2010
8/8/2019 Sierra Leone's Maternal Health and Health Human Resource Situation, Glenn Benablo
“Sister Evelyn is one of the few Sierra Leoneans with high degree of integrity. She is verystraight-forward and a very modern woman. She wants to keep in trail with the world
trends. I admire her as a counterpart and as a friend. Working with her is one of the
greatest things that happened to me in Makeni.” Anita Aguila, VSO Nurse Volunteer
Sister Evelyn. Tee and I visited the Northern
Polytechnic School of Nursing in Makeni where
I met Sister6
Evelyn Bangura, the head of the
nursing department. Like Tee, Sister Evelyn is
also a Nurse and has two kids. She is new in theposition as head of the department and she
works really hard to improve the quality of
nursing education of the school and literally the
entire nation. The challenge is made even
bigger with the complexities on undoing the
mismanagement and irregular transactions
made by the previous management
I was so surprised to learn that there is only one stethoscope and one sphygmomanometer in
the skills laboratory being used by many nursing students. For a learning institution it was also
surprising to learn that the school does not keep academic records of previous students. An
alumnus/a will never ever see his/her records again if he/she has lost her original copy. Sister
Evelyn said that an IT VSO volunteer with experience in management information system (MIS)
would greatly help the school. There is just one old computer for the entire school that is
locked somewhere; but that’s the least of the problem as there is no regular power supply
anyway and the teachers are not computer literate. So it doesn’t really matter if they only have
one computer.
It was uncomfortable to see more than 150 students packed in one room without ventilation,
without textbooks, and teachers without a sound system to ensure that they are heard by
everyone. Teachers make do with an old blackboard and limited supply of chalks. The most
surprising of all is that the school has no water supply. I cannot believe a nursing school without
running water. I reckon hand-washing technique would have been a big challenge to teach.
6Nurses in Sierra Leone are also called sisters.
8/8/2019 Sierra Leone's Maternal Health and Health Human Resource Situation, Glenn Benablo
to visit a clinic because they do not have medicines and doctors. Kayima delivered both her
pregnancies at home. After giving birth to her youngest kid, she started selling goods on the
street to help augment her husband’s income. She was so happy that I bought a pair of slippers
because she needed some money to buy medicines for her sick boy. She said that if only the
government can provide free medicines and free services to poor people, she would have notleft her kids who were sick and all alone at home.
Kayima dreams of becoming a nurse but because of financial reasons, she was not able to
follow her dream. She got married instead. Her husband wants to have more kids.
Commonalities
Tee, Sister Evelyn and Kayima are not totally different from each other. They share
commonalities as they are all in reproductive age, they are working mothers, they all have twokids each, they experienced two pregnancies and they are all nurses. Well, Kayima dreams of
becoming one.
Their individual experiences being a woman in Sierra Leone had confronted them with many
realities around the health situation of the country. The three of them wished to see Sierra
Leone with improved health care delivery system in the future – where quality standard health
services are accessible, where doctors are available in the clinics and where education in health
is at par with the rest of the world.
For Kayima, health human resource is an issue at the community level. For Sister Evelyn, humanresource is an issue within the health education system. And for Theresa, human resource is an
issue around all levels of health care. These women from different walks of life speak one voice
on behalf of all women in Sierra Leone.
Ways Forward
The stories and the issues raised by Tee, Sister Evelyn
and Kayima were validated by the stakeholders in
Tongkolili District. I was very privileged to be part of
the first ever stakeholders’ consultative meeting
conducted in the district attended by more or less
thirty very passionate citizens. Mr. Jalloh, the director
8/8/2019 Sierra Leone's Maternal Health and Health Human Resource Situation, Glenn Benablo
(MRC) was kind enough to quickly organize the said meeting at the
time when Tee and I suggested it during our visit to his office in Freetown. It was an amazingly
good experience to see the MOHS authorities, district health management team, chiefdom
leaders, representatives from local and international NGOs9, health professionals, Christian and
Muslim groups, teachers and some members of the community gather together to share storiesof successes and disappointments. It was also a venue to discuss the plans to address
challenges, to discuss issues and to plan enthusiastically.
Just outside the conference room I saw hundreds
of people queuing patiently in the hope of getting
some health services. It is a usual daily sight
according to Chief Kholifa Rowalla, who was
seated right next to me. It was heartbreaking to
hear the leaders begging for support from VSO
and MRC. They were begging for things that they
rightfully should have. They altogether begged for
VSO Sierra Leone (VSO SL) developed a Program in Health in October 2007 to respond primarily to and identified
need for more human resources for health in Sierra Leone. To this end, international volunteers were placed withintraining institutions to train most cadres of health care workers including State Enrolled Community Health Nurses,
(SECHNs), State Registered Nurses (RN), BSN, Community Health Officers (CHO), Community Health Assistants
(CHA) and Midwives. In addition, volunteers were also based in a government hospital to deliver in-service training
and ongoing mentoring and supervision (Clinical education) to facilitate the improvement of quality nursing education
and prepare Nursing students in their critical role in the promotion of health, prevention and treatment of illnesses to
address the pressing overall health problems in Sierra Leone.
Following the Health Program Area review in March 2009 it was clearly seen that training and increasing human
resources for health itself cannot meet the numerous challenges in the health sector, especially so when the
government cannot readily absorb the health workers after graduation.
Programme Objectives:
1. Strengthen Human Resources for Health in Sierra Leone through increasing the number of trained and
retained State Enrolled Community Health Nurses, Community Health Officers, Community Health
Assistants, State Registered Nurses and Midwives.
2. Raise standards of nursing care in four district hospitals through supporting improvement in wards and
hospital management.
3. Support District Health Management teams in four district hospitals to manage the delivery of improved and
more inclusive Primary Health Care to vulnerable communities.
4. MOHS at central level shows increase capacity in key aspects of management; HIMS, HR management,
health service coordination.
List of key skills that VSO sends to Sierra Leone
1. Doctors – General Practitioners, Pediatricians, Ob-gynecologists, Surgeons for government hospitals and
clinics
2. Medical Lectures – Doctor lecturers, nurse teachers and midwife tutors for government and private medical,
nursing and midwifery schools.
3. Nurses/Midwives – Hospital nurses/midwives and nurse/midwife clinical instructors for government hospitals
4. Health Managers – Doctors, Nurses and other allied health professionals with management experience to
work with the ministry and district level management teams.
5. IT/MIS Specialists – IT experts with MIS experience for the schools and health facilities
6. HR Advisers – HR professionals to work with the ministry and district level management teams