The Challenge
Sierra Leone has one of the highest maternal mortality rates globally. Teenage pregnancies are common and adolescent deaths constitute nearly 25 percent of the total maternal deaths in the country. More than half of all childhood deaths are preventable with access to key interventions. There are also persistent deficits in quality of care and efficiency of resource use in the health system. The 2013 Ebola outbreak further weakened the public health system and was associated with a 15-25 percent drop in RMNCAH service use.
The GFF Partnership Response
The Government, as part of the Post-Ebola recovery response, developed a new national policy guidance, National Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) Strategy that prioritizes health systems strengthening, improving quality in the delivery RMNCAH services, strengthening community engagement and involvement improving health information systems, research, monitoring and evaluation. The GFF partnership works with the government of Sierra Leone to improve the efficiency of available resources by rightsizing the health sector, redesigning the performance-based financing program, improving the coordination and alignment of external resources, and pushing resources down to the frontlines; support development of the health financing strategy and implementation plan and strengthen the prioritization and monitoring system of the RMNCAH strategy, including the focus on adolescent health.
Furthermore, support will be provided to improve decentralized public financial management by building the capacity of district health management teams to use health data for effective decision making. Partners that contribute to financing Sierra Leone’s priorities as outlined in the investment case include the GFF, Gavi, Global Fund, Partners in Health, UNICEF, USAID, World Bank, and the governments of Germany (KFW), Italy, Japan (JICA), and United Kingdom (DFID).
Progress
The GFF engaged partners through the country platform to review the terms of reference for the Mid-Term Review of the investment case (RMNCAH Strategy). Partners agreed to enlarge membership to include other stakeholders for effective coordination of implementation of the strategy. Ongoing technical support is being provided on results and monitoring. A Health Financing System Assessment is also underway to identify reforms needed.
There has been strong collaboration between the GFF and World Bank health project, working with the Ministry of Health to develop the new project concept note, including the development of a theory of change and results framework. The project has a strong, health systems focus including: strengthening information systems and data use for patient management, referrals and decision-making, and strengthening health financing systems through support for budget development and expenditure management, improved domestic resource mobilisation and establishing health resources tracking mechanism.