Leone Health Research Articles

Community Health Workers' Experiences in Strengthening the Uptake of Childhood Immunization and Malaria Prevention Services in Urban Sierra Leone.

Introduction: Community health workers (CHWs) play an integral role in Sierra Leone's health systems strengthening efforts. Our goal was to understand CHWs' experiences of providing immunization and malaria prevention services in urban settings and explore opportunities to optimize their contributions to these services.Methods: In 2018, we conducted an exploratory qualitative assessment in the Western Area Urban district, which covers most of the capital city of Freetown. We purposively selected diverse health facilities (i.e., type, ownership, setting) and recruited CHWs through their supervisors. We conducted eight focus group discussions (FGD) with CHWs, which were audio-recorded. The topics explored included participants' background, responsibilities and priorities of urban CHWs, sources of motivation at work, barriers to CHWs' immunization and malaria prevention activities, and strategies used to address these barriers. The local research team transcribed and translated FGDs into English; then we used qualitative content analysis to identify themes.Results: Four themes emerged from the qualitative content analysis: (1) pride, compassion, recognition, and personal benefits are important motivating factors to keep working as CHWs; (2) diverse health responsibilities and competing priorities result in overburdening of CHWs; (3) health system- and community-level barriers negatively affect CHWs' activities and motivation; (4) CHWs use context-specific strategies to address challenges in their work but require further support.Conclusion: Focused support for CHWs is needed to optimize their contributions to immunization and malaria prevention activities. Such interventions should be coupled with systems-level efforts to address the structural barriers that negatively affect CHWs' overall work and motivation, such as the shortage of work supplies and the lack of promised financial support.

Responsibility, repair and care in Sierra Leone's health system

Central to the workings of a hospital are the technical and bureaucratic systems that ensure the effective coordination of information and biological materials of patients across time and space. In this paper, which is based on ethnographic research in a public referral hospital in Freetown, Sierra Leone, conducted between October 2018 and September 2019, we adopt a patient pathway approach to examine moments of breakdown and repair in the coordination of patient care. Through the in-depth analysis of a single patient pathway through the hospital, we show how coordination work depends on frequent small acts of intervention and improvisation by multiple people across the pathway, including doctors, managers, nurses, patients and their relatives. We argue that such interventions depend on the individualisation of responsibility for ‘making the system work’ and are best conceptualised as acts of temporary repair and care for the health system itself. Examining how responsibility for the repair of the system is distributed and valued, both within the hospital and in terms of broader structures of health funding and policy, we argue, is essential to developing more sustainable systems for repair.

Sierra Leone's Health Facilities’ Electricity, Computing-Hardware, and Internet Infrastructures

Background: Years of health information (HIS) investment in many countries has facilitated service delivery surveillance, reporting, and monitoring. Electricity, computing hardware, and internet network are vital for health facility-based information systems. Availability of these infrastructures at health facilities are crucial for achieving the national digital health vision. Objectives: The objective of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample. Method: We sampled Seventy-two health facilities distributed in all the districts in Sierra Leone, factoring in rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over two weeks period. Result: We found that 82% of surveyed health facilities do not have institutionally provided internet. The maternal and child health posts (MCHP) one type of primary healthcare unit (PHU) reported 60% have solar as their only electricity source, and the other 40% had no electricity source. Similarly, 38% of hospitals use generator as a primary electricity source, while 46% use national utility. All hospitals have at least one functional computer, though only seven of the 13 hospitals have four or more functional computers. Similarly, only two of the 59 PHUs had one computer each, and 37 of the PHUs have one tablet device. Discussions: This healthcare infrastructure mapping provides the current state of internet connectivity, electricity, and computing hardware at health facilities in Sierra Leone. We can say with a 95% confidence level that alternative and non-traditional internet, electricity, and computing hardware are emerging as preferred options for health facility digital health coverage. Conclusion: Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. Forty-three percent of surveyed health facilities believe inadequate electricity is the biggest threat to digitization. The current trend where all health facility internets are provided by GSM service providers can be changed to other promising alternatives. This study has shown evidence of the critical gap necessary to achieve this result. Funding Information: The Ministry of Health and Sanitation was supported for this study by United Nations Children’s Fund (UNICEF) with support from United States Agency for International Development (USAID). The University of Malta also supported this research. Declaration of Interests: None to declare.

Public Confidence in the Health Care System 1 Year After the Start of the Ebola Virus Disease Outbreak — Sierra Leone, July 2015

Ensuring confidence in the health care system has been a challenge to Ebola virus disease (Ebola) response and recovery efforts in Sierra Leone (1). A national multistage cluster-sampled household survey to assess knowledge, attitudes, and practices (KAP) related to Sierra Leone's health care system was conducted in July 2015. Among 3,564 respondents, 93% were confident that a health care facility could treat suspected Ebola cases, and approximately 90% had confidence in the health system's ability to provide non-Ebola services, including immunizations, antenatal care, and maternity care. Respondents in districts with ongoing Ebola transmission ("active districts") and respondents with higher educational levels reported more confidence in the health care system than did respondents in nonactive districts and respondents with less education. Active districts were the focus of the Ebola response; these districts implemented intensified social mobilization and communication efforts, and established district response centers, Ebola-specific health care facilities, and ambulances. Greater infrastructure and response capacity might have resulted in higher confidence in the health care system in these areas. Respondents ranked Ebola and malaria as the country's most important health issues. Health system recovery efforts in Sierra Leone can build on existing public confidence in the health system.

When free healthcare is not free. Corruption and mistrust in Sierra Leone's primary healthcare system immediately prior to the Ebola outbreak.

Sierra Leone is one of three countries recently affected by Ebola. In debates surrounding the circumstances that contributed to the initial failure to contain the outbreak, the word 'trust' is often used: In December 2014, WHO director Margret Chan used 'lack of trust in governments'; The Lancet's Editor-in-Chief, wrote how Ebola has exposed the '… breakdown of trust between communities and their governments.' This article explores the lack of trust in public healthcare providers in Sierra Leone, predating the Ebola outbreak, apparently linked to widespread petty corruption in primary healthcare facilities. It compares four NGO-supported accountability interventions targeting Sierra Leone's primary health sector. Field research was conducted in Kailahun, Kono and Tonkolili Districts, based on interviews with health workers and focus group discussions with primary healthcare users. Field research showed that in most clinics, women and children entitled to free care routinely paid for health services. A lack of accountability in Sierra Leone's health sector appears pervasive at all levels. Petty corruption is rife. Understaffing leads to charging for free care in order to pay clinic-based 'volunteers' who function as vaccinators, health workers and birth attendants. Accountability interventions were found to have little impact on healthworker (mis)behaviour.

Sierra Leone's health workforce crisis: Drivers of suboptimal distribution and poor retention of primary healthcare workers in rural areas

Outcomes & Evaluation: To date, we have established the first Department of Environmental and Occupational Health in the country, built sustainable multidisciplinary local and international Public-Private Partnership, started graduate level degree programs, obtained full scholarship and research grants, and organized national and international research conferences to promote collaboration and knowledge sharing. Going Forward: We are working to further strengthen our program and improve its sustainability in order to improve EOH in the country by expanding our outreach, extending our collaborative network, serving as a bridge between public and private sectors, helping to adopt international environmental and occupational safety standards in the country, and promoting evidence based policy by conducting research. Funding: We have been proactive and creative in sourcing funding and have obtained funding from different public and private institutions. Abstract #: 01ETC072

Haja Zainab Bangura: Sierra Leone's tireless Minister of Health

Haja Zainab Bangura: Sierra Leone's tireless Minister of Health

Global health: Will positive changes for Sierra Leone's health professionals mean the end of its Brain Drain?

Global health: Will positive changes for Sierra Leone's health professionals mean the end of its Brain Drain?

The Roles and Responsibilities of a Foreign Service Health Practitioner: Serving in a Developing Country

Foreign service health practitioners (FSHPs) support the realization of the goals and objectives of U.S. embassies and ensure the health unit's operational capacity, from the treatment of minor emergencies to evacuating a patient for advanced emergency care. Effective planning for emergencies as a result of a terrorist attack, natural disaster, or highly communicable disease is contingent on the level of emergency preparedness. A FSHP is uniquely positioned to focus on critical issues involving the assessment of local health care resources and preparing for medical emergencies. This is especially true for assessing the availability and functionality of local medical resources in a developing country such as Sierra Leone, West Africa. The serious deficiencies in Sierra Leone's health system and its lack of ability to respond to medical emergencies demand the FSHP to integrate special knowledge, skills, and abilities that are essential for managing the overall health care services provided at the embassy's health unit.