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

Pieterse, Pieternella; Lodge, Tom

doi:10.1093/inthealth/ihv024

Cited by 66 publications

(43 citation statements)

References 2 publications

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“…Out of pocket payment for health care coupled with the low socio economic status of the survivours are enough to prevent hospital patronage. The poor health care state precedes the outbreak of EVD [15]. Most of the health facilities give blanket treatment which may not be effective to tackle the complaints posed by the survivours.…”

Section: Discussionmentioning

confidence: 99%

Health Problems of Ebola Virus Disease Survivours in Sierra Leone, 2015: Making a Case for Follow-Up Care After Discharge from Ebola Treatment Centres

Nabena¹,

Bakare²,

Ilesanmi³

et al. 2015

MEDJ

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Background : The number of the survivours of the Ebola Virus Disease (EVD) is increasing. They have reported health problems. Objective: This study aimed to document the health problems of EVD survivour in Bombali District Sierra Leone. Methods: This was a cross sectional study conducted at Bombali District, Sierra Leone in February, 2015. Participants were EVD survivours admitted and discharged from September, 2014 to February 2015. In all, 304 survivours participated in the study by filling an interviewer administered questionnaire. Data were analyzed with SPSS version 21.0 using descriptive statistics. Association between independent variables was explored with chi square test. The level of statistical significance was set at p <0.05. Results: The median age of survivour was 24 years (range 1-89 years), 105 (34.5%) were <18 years, and more than half of the total responders (60.9%) were females, 92 (30.3%) were discharged in November, 2014. All 189 (62%) had health problem: 65 (34%) and 124 (66%) had single and multiple complaints respectively. Joint pain was reported by 111(58.7%), generalized body pain – 91(48.1%), headache – 81(43%), eye problems – 65(34%), psychological problems – 63(33%). Only 2 (1.06%) survivours have sought for help. Among survivours of 18 years and above, 148(74.4%) had health problems p<0.001. Health problems were reported by 101(70.1%) of survivours with no formal education p=0.002. Also, 52(83.9%) widow(er) had health problems p<0.001. Conclusion: There is a need for the establishment of survivour’s clinic. Provision of specialized care for survivour is encouraged based on their identified needs. This can be done early to avoid complications.

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Section: Discussionmentioning

confidence: 99%

Health Problems of Ebola Virus Disease Survivours in Sierra Leone, 2015: Making a Case for Follow-Up Care After Discharge from Ebola Treatment Centres

Nabena¹,

Bakare²,

Ilesanmi³

et al. 2015

MEDJ

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“…This institutional barrier violates both the mother's and child's rights and reflects major imbalances in power and control. A similar phenomenon was reported in Sierra Leone, where patients were often required to pay for health services, including their child's immunization record, despite stipulation that healthcare is free [60]. Women disproportionately suffer the consequences of additional out of pocket expenditures [57].…”

Section: Discussionmentioning

confidence: 60%

Misoprostol for the prevention of post-partum haemorrhage in Mozambique: an analysis of the interface between human rights, maternal health and development

Hobday

Zwi

Homer

et al. 2020

BMC Int Health Hum Rights

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Background: Mozambique has high maternal mortality which is compounded by limited human resources for health, weak access to health services, and poor development indicators. In 2011, the Mozambique Ministry of Health (MoH) approved the distribution of misoprostol for the prevention of post-partum haemorrhage (PPH) at home births where oxytocin is not available. Misoprostol can be administered by a traditional birth attendant or self-administered. The objective of this paper is to examine, through applying a human rights lens, the broader contextual, policy and institutional issues that have influenced and impacted the early implementation of misoprostol for the prevention of PPH. We explore the utility of rights-based framework to inform this particular program, with implications for sexual and reproductive health programs more broadly.Methods: A human rights, health and development framework was used to analyse the early expansion phase of the scale-up of Mozambique's misoprostol program in two provinces. A policy document review was undertaken to contextualize the human rights, health and development setting in Mozambique. Qualitative primary data from a program evaluation of misoprostol for the prevention of PPH was then analysed using a human rights lens; these results are presented alongside three examples where rights are constrained. Results: Structural and institutional challenges exacerbated gaps in the misoprostol program, and sexual and reproductive health more generally. While enshrined in the constitution and within health policy documents, human rights were not fully met and many individuals in the study were unaware of their rights. Lack of information about the purpose of misoprostol and how to access the medication contributed to power imbalances between the state, health care workers and beneficiaries. The accessibility of misoprostol was further limited due to dynamics of power and control.(Continued on next page)

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“…Challenges with health system inputs including weak supply chains 12 and limited health workforce 13 14 mean that service availability is not constant but in ux and highly dependent on time and location. This contributes to underutilization of available services, 12 frequent bypassing of levels of care 15 and a loss of trust when reported services are not available 16 . Prior to 2017 there was no formal referral system to map the changing service availability landscape and ensure patients were sent to the correct facility and at the correct time to receive care.…”

Section: Introductionmentioning

confidence: 99%

An Observational Study of a National Referral System: An Analysis of 14,266 Referrals in Sierra Leone

Youkee¹,

Bangura²,

O’Neill³

et al. 2020

Preprint

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Background Referral systems are critical to a well-functioning health system. In 2017, a special cadre of referral coordinators were trained and deployed at every district and tertiary hospital in Sierra Leone. We analyse the referrals coordinated by the network to understand health service utilisation, referral pathways and outcomes.Methods A retrospective observational study of incoming referrals to all district and tertiary hospitals in Sierra Leone from 1st November 2017 until 31st October 2018. Multivariate analysis was performed on all referrals and a subgroup analysis of urgent referrals (n=10,865). Hospital preparedness and readiness scores were sourced from the Service Availability and Readiness Assessment 2017.Results 14,266 referrals were captured over the 12 months. Referral indices ranged from 0·51-5·97, with the highest indices found in Freetown and Pujehun. Bed occupancy ranged from 36·8-83·3%. 606 deaths were recorded, mortality rate per referral was 4.25%, with the majority of deaths, 446 (73.60%) occurring in the U5 population. Higher OR for mortality are seen from referrals originating from higher levels of the health system. The OR for mortality for a referral from the lowest level, MCHP, was 0.77, whilst from tertiary level was 2.40 (MCHP 0·77, CHP 0·90, CHC 1·40, district 2·06 and tertiary 2·40). For urgent referrals, factors associated with mortality were U5s, adult non-maternity cases and being seen by a clinician within one hour. Referrals from district hospitals to tertiary hospitals only accounted for 0·5% of all referrals. No correlation was found between referral index, bed occupancy and hospital service availability and readiness scores. The study did not detect any difference in total number of national referrals during the rainy season.Conclusions Wide variations in bed occupancy and referrals by district highlight disparities in health service utilisation. Low rates of referral from district hospitals to tertiary care should be further investigated. Referral indices and referral mortality rates are useful to monitor over time and to make inter district comparisons. Referral systems and pathways are useful indicators of health service utilisation and further research should be undertaken to standardise definitions and identify performance indicators for referral systems in low resource settings.

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

Cited by 66 publications

References 2 publications

Health Problems of Ebola Virus Disease Survivours in Sierra Leone, 2015: Making a Case for Follow-Up Care After Discharge from Ebola Treatment Centres

Health Problems of Ebola Virus Disease Survivours in Sierra Leone, 2015: Making a Case for Follow-Up Care After Discharge from Ebola Treatment Centres

Misoprostol for the prevention of post-partum haemorrhage in Mozambique: an analysis of the interface between human rights, maternal health and development

An Observational Study of a National Referral System: An Analysis of 14,266 Referrals in Sierra Leone

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

Cited by 66 publications

References 2 publications

Health Problems of Ebola Virus Disease Survivours in Sierra Leone, 2015: Making a Case for Follow-Up Care After Discharge from Ebola Treatment Centres

Health Problems of Ebola Virus Disease Survivours in Sierra Leone, 2015: Making a Case for Follow-Up Care After Discharge from Ebola Treatment Centres

Misoprostol for the prevention of post-partum haemorrhage in Mozambique: an analysis of the interface between human rights, maternal health and development

An&nbsp;Observational Study of a National Referral System: An Analysis of 14,266 Referrals in Sierra Leone

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An Observational Study of a National Referral System: An Analysis of 14,266 Referrals in Sierra Leone