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.
Sierra Leone’s RMNCAH-N strategy provides focused and prioritized set of high impact interventions for accelerating reduction of maternal, newborn, child and adolescent deaths. The strategy is aligned with national documents such as the Health Sector Recovery Plan and its global commitments, including the SDGs and the New Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030.
Priorities identified in the investment case include:
- Strengthen health systems for effective provision of RMNCAH-N services, including by ensuring adequate, skilled and motivated human resources for health; strengthening leadership and governance at all levels; ensuring availability of essential RMNCAH-N drugs, supplies and equipment; developing infrastructure; ensuring availability of a functioning emergency referral system; and providing safe blood at all Comprehensive Emergency Obstetric and Newborn Care facilities).
- Improve the quality of RMNCAH-N services at all levels of service delivery: Support implementation of a national RMNCAH-N quality improvement program and systematic quality improvement procedures, approaches and practices, with a special focus on emergency triage assessment and treatment, respectful maternity care, and Maternal Perinatal Death Surveillance Review (MPDSR).
- Strengthen community systems for effective delivery of RMNCAH-N services by addressing sociocultural, geographical and financial barriers; implementing integrated community case management-plus; promoting implementation of RMNCAH-N interventions at the community level, including social accountability; and address other sector determinants.
- Strengthen health information systems, monitoring, evaluation, and research for effective RMNCAH-N service delivery, and strengthen civil registration and vital statistics systems.
How the GFF partnership works in Sierra Leone
The GFF partnership focuses on improving coordination and alignment between donors, ministries, and implementing partners in the health sector through the development of a prioritized and realistic implementation plan that accounts for available resources and capacity constraints. The GFF works with the government of Sierra Leone to focus on mobilizing domestic financial resources for health, enhancing the efficiency of the health system through strategic purchasing of services, supporting appropriate distribution of health facilities and staff, and improving quality of care.
To ensure long-term sustainability and possible scale-up of key interventions, the GFF supports the development of a health financing strategy to increase efficiency and domestic resources for the health sector. The GFF provides technical support for monitoring the revenue impact of increased tobacco taxes, conducting analysis on potential efficiency gains in health financing, and refining results-based financing (RBF). RBF will be piloted in two districts in 2019 and is expected to be instrumental in providing financing to the front lines for maternal, child, and adolescent health services. The RBF pilot is also expected to help ensure that the distribution of health services better reflects the needs in Sierra Leone. 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.
Financing Sierra Leone’s Priority Investments
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).