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Sierra Leone Social Health Insurance (SLeSHI): A sure way of solving the country’s health challenge

July 28, 2017 By Alusine Sesay

Despite immeasurable boost in the Sierra Leone health sector, courtesy of international partners’ interventions, the country still grapples with the challenge of providing affordable health care services for its citizens. People die of preventable and curable diseases basically as a result of the fact that the country’s health system is still challenging. There is little or no better structure to cater for the least in society to access affordable and better healthcare. And the people that suffer most are the poor and vulnerable. They die of diseases that could be prevented or cured simply because they can’t afford to pay medical bills.

The outbreak of Ebola in 2014 exposed the country’s weak health system .Owing to the weak health system, the disease which initially surfaced in a small village in the Eastern District of Kailahun, spread countrywide and killed thousands of people including health practitioners. In 2015; Sierra Leone was rated by the United Nations Development Programme (UNDP) as one of the least countries to live in the world. In its 2015/16 Human Development Index Report (HDI), UNDP placed Sierra Leone in the category of low human development countries, which is primarily as a result of the pervasive poverty and the inaccessibility of basic health care facilities.

The report stated that, “Extreme poverty and poor health care have resulted in the devastatingly poor health outcomes. The country has the worst infant and child mortality rate in the world. For every 1,000 live births in the West African nation, more than 100 infants die. Also, more than 160 children die before they reach the age of five out of every 1,000 Sierra Leonean children.

In 2010, President Ernest Bai Koroma launched the Free Healthcare Initiative for pregnant women, lactating mothers and children under five. Despite Numerous gains made, the scheme is still being plagued with numerous challenges such as massive corruption, misappropriation of funds and embezzlement, thus affecting women and children, who continue to die in their numbers.

While delivering a speech during the launch of the Maternal Death and Surveillance Report (MDSR), on 31st May 2017, UNFPA Representative in Sierra Leone, Kim E. Dickson, noted that, “maternal mortalities continue to rise in Sierra Leone among the most vulnerable and marginalized women and girls. For example, in 2014, the estimated total number of maternal deaths was 226. In 2015, there were 456 deaths, and in 2016 as noted in the latest MDSR report, there were 706 maternal deaths.

According to him, “Sierra Leone has one of the world’s highest estimated maternal mortality ratio of 1,165 deaths per 100,000 live births while in the United Kingdom for example, it is only 9 deaths per 100,000. Even in neighboring Ghana it is only 319 per 100,000! The sad truth is that most of these deaths of pregnant mothers can be prevented if adequate care is available and provided. The worrying trend illustrates that the number of maternal mortalities in Sierra Leone has been increasing considerably over the years.

The grim statistics about the country’s health sector justifies the need for a scheme that would overhaul the entire system and cater for the least in society. And, it is by no mistake that the government, through the National Social Security and Insurance Trust (NASSIT), Ministry of Health and Sanitation and Ministry of Labour and Social Security, has initiated the Sierra Leone Social Health Insurance (SLeSHI) scheme that would cater for the most vulnerable to access quality health care service in the country.

The Free healthcare initiative, in my view, is faced with numerous challenges because it is largely being funded by government and donor partners. Its sustainability could be questionable because government is sometimes financially overstretched, having to finance several development projects. It is no gainsaying that the multi-sectoral approach of SLeSHI would help minimize some of the challenges bedeviling the Free Healthcare Initiative. Also, with minimal contributions from the public through the health insurance scheme, the free health care could be sustainable. The public would be seen as part of the process, hence would own and protect it for the betterment of all and sundry.

According to the National Coordinator of SLeSHI,Dr.Joseph Kamara, the scheme would cover free health care for children from 0-12 years, lactating mothers, pregnant women, mentally retarded, retired civil servants and the very poor who cannot afford to pay for medical care.

He said the scheme would be addressing mainly Primary Health Care issues that affect over 70% of the country’s population.

He further observed that the current healthcare financing system in the country was not sustainable as it is plagued with high Out Of Pocket (OOP) health expenditure, thus making many people not to access healthcare at the time of need, while serving as a conduit for majority of the poverty cases as most households spent a very high percentage of their income on health.

Within the Sub Saharan Africa, Sierra Leone is among a few countries that have not been implementing social health policy for its citizens. Although there are private health insurances for employees of certain institutions, with a few government institutions like the military and police implementing health insurance, bulk of the country’s  population are not enrolled in any health insurance scheme. This particular trend has a telling negative effect on the country’s health system; hence people are dying of curable diseases on a daily basis. In countries including Ghana, Senegal, Botswana and Kenya, where health insurance is being implemented, a huge chunk of the population is assured of accessing quality health service. The scheme, if properly implemented in Sierra Leone, would absolutely reduce poverty and help improve the country’s health infrastructure.

According to a study conducted by WHO on the impact of health insurance, there is strong evidence that Community Based Health Insurance and the Social Health Insurance, which are  mainly practiced in Ghana, improve resource mobilization for health and that it improve health service utilization and provide financial protection for members in terms of reducing their out-of-pocket expenditure.

“CBHI and SHI hold strong potential to improve financial protection and enhance utilization among their enrolled populations, and they can also foster social inclusion. This underscores the importance of health insurance as an alternative health financing mechanism capable of mitigating the detrimental effects of user fees, and as a promising means for achieving universal health-care coverage.”

Interestingly, life expectancy in countries where health insurance scheme is being implemented is far better than in countries where the scheme is not in existence. According to WHO’s 2015 data, life expectancy in Ghana significantly increased from 61.31 years in 2014 to 61.49 years in 2015.In Botswana, life expectancy increased from 64.43 years in 2014 to 64.49 years in 2015, and was ranked 150th position in the world ranking, out of 191 countries. In Senegal, Life Expectancy increased from 66.37 in 2014 to 66.80 years in 2015, and the country was ranked 135th position, while life expectancy in Sierra Leone was 46.0 which gave the country a World Life Expectancy ranking of 178.The report indicates that Sierra Leone has the world’s lowest life expectancy for both sexes-that is 50.8 years for women and 49.3 years for men. And the major causes of death in Sierra Leone, as outlined by WHO includes,Infleunza and Pneumonia,Turberculosis,Malnutrition,Maternal and child mortality  conditions,Malaria,Measles,Birth Truama,Diabetes Mellitus,Diarrhoeal diseases, among a host of other primary healthcare diseases. These are preventable and curable diseases which the country’s health system cannot adequately handle.

It is by no magic that people live longer in Ghana, Botswana, and Senegal than in Sierra Leone. The simple reason is that those countries have structured and well-functioning  health insurance schemes for their citizens, hence the effective implementation of the Social Health Insurance Scheme in Sierra Leone would go a long in solving not only the country’s health challenges, but would also help in  reducing  poverty among citizens. I am strongly optimistic that Sierra Leone can do it better, because we have a lot to learn from countries where the scheme is being implemented.