Maternity Crisis in Sierra Leone
There is a maternity crisis in Sierra Leone. The country has the highest maternal death rate in the world, with one in 17 women dying from pregnancy or birth complications. This number could be even higher, as Sierra Leone’s 2017 Maternal Death and Surveillance Report estimated that seven in 10 maternal deaths go unreported. Below are seven facts about the maternity crisis in Sierra Leone.

Top 7 Facts About the Maternity Crisis in Sierra Leone

  1. The Majority of Maternal Deaths are Preventable: The top causes of maternal death in Sierra Leone are bleeding, pregnancy-induced hypertension, infection and unsafe abortions, all of which are preventable through adequate medical treatment, according to the World Health Organization. Bleeding is a particularly difficult problem for under-served rural areas where mothers do not have access to health care facilities. Another issue facing mothers is infrastructure. People poorly maintain many roads between towns and clinics and these make for a difficult journey for sick and laboring women. Again, road maintenance is a simple problem that can help reduce maternal death in Sierra Leone.
  2. The Majority of Mothers are Under 20: One hundred and twenty-five out of 1,000 mothers in Sierra Leone are under age 20 according to a 2017 United Nations Population Fund (UNFPA) study. Maternity in Sierra Leone is particularly dangerous for adolescent mothers and 20 percent of maternal deaths in Sierra Leone were among teenagers. Beyond maternal death, pregnant teenagers in Sierra Leone lose out on life prospects – a 2015 law banned pregnant girls from attending school, and parents describe teenage pregnancy as the “ultimate shame” for a family.
  3. The 2014-2015 Ebola Crisis Halted Progress: Before 2014, Sierra Leone was making progress in reducing maternal death – from 2000 to 2015, maternal deaths dropped by 4.4 percent. However, the Ebola epidemic caused an immediate increase in maternal death through 2015. Sierra Leone planned to meet many Millennium Development Goals by 2015, but the May 2014 Ebola outbreak reversed progress, particularly in maternal health. Not only did Ebola put a strain on general health care in Sierra Leone, but it also dramatically reduced the number of health care workers in the country. A 2016 World Bank report estimated that maternal death could increase by 74 percent due to the extreme shortage of health care workers in the country.
  4. Programs for Maternity Care Still Need Funding: There is a dearth of doctors in Sierra Leone. For example, in the district of Bonthe, there are nine doctors for 220,000 patients and only 44 percent of births receive support from a nurse or midwife. Unfortunately, between the civil war from 1991 to 2001 and the 2014 to 2015 Ebola outbreak Sierra Leone, the burgeoning health care system in Sierra Leone lost momentum. The E.U., the U.N. and UNICEF have all devoted funds to maternity in Sierra Leone in addition to Partners in Health and other nonprofit organizations. Donations are critical to moving forward with maternal health.
  5. Sierra Leone’s Government has Committed Itself: President Julius Maada Bio announced in October 2019 that Sierra Leone increased its health budget from 8.9 percent to 11.5 percent of the country’s national budget to help combat dangerous maternity in Sierra Leone. On October 18, 2019, Sierra Leone opened a $1.6 billion maternity facility in Freetown to better serve the country’s largest city. Sierra Leone also launched a free health initiative in 2010 to help improve pre- and post-partum care. The government’s goal for maternity in Sierra Leone is to meet Millennium Development Goals by 2030, reducing the global maternal mortality ratio to less than 70 per 100,000 live births.
  6. Nonprofits are Deeply Involved: Multiple nonprofit organizations, including UNICEF, Partners in Health and the Borgen Project have covered issues with maternity in Sierra Leone. Partners in Health has been particularly successful, building a maternal waiting home and opening a health clinic in Kono in 2018. UNICEF provided safer water for mothers to help with illness and sanitation. These nonprofits prove that the crisis is not insurmountable.
  7. Celebrities are also Getting Involved: In October 2019, vlogbrothers, run by Hank and John Green, pledged $6.5 million to Partners in Health as part of his family’s initiative to bring awareness to maternity in Sierra Leone. John Green discussed how he traveled to Sierra Leone and saw first-hand the lack of hospital electricity, medical equipment and transport. He praised the efforts of the Partners in Health in developing a large-scale hospital system and making systematic changes and he asked anyone who can donate to do so. Currently, the vlogbrothers have a goal of $240,000 per month in donations – so far, they have approximately $194,000. The vlogbrothers are also providing updates on their donations and work with Partners in Health in Sierra Leone.

Motherhood should not be a gamble. Families around the world deserve to look forward to pregnancy and birth and not feel distressed. Multiple organizations are pushing for progress, but more is necessary. Support in any form, from awareness to donations, can only help the crisis of maternity in Sierra Leone.

Melanie Rasmussen
Photo: Flickr

Sierra Leone Health Care
Access to quality health care in Sierra Leone has been an ongoing struggle for many people in the country due in part to a history of war and conflict. Poor living conditions also have an impact on the percentage of the population with access to essential, life-saving health care services. Of note, in Sierra Leone, 73 percent of rural citizens live in poverty. Fortunately, both local and international powers are making attempts to change the status quo in order to create a more promising future for Sierra Leoneans. Keep reading to learn more about efforts to improve.

5 Ways Health Care is Improving in Sierra Leone

  1. In September 2017, the Ministry of Health and Sanitation proposed the National Health Sector Strategic Plan. The plan outlines how years after the Ebola outbreak of 2014, the disease still impacts survivors’ daily lives. The Ministry of Health and Sanitation proposes a long-term recovery plan to last until 2021. The proposal states its vision of “A well-functioning national health system that delivers efficient and high-quality healthcare and ultimately contributes to the socio-economic development of the country. This care must be of high quality, accessible, affordable and equitable to all Sierra Leoneans.”
  2. In 2017, the International Organization for Migration began the Strengthening Sierra Leonean National Health Care Capacity through Diaspora Engagement project. This project connects health care professionals in Sierra Leone with residents in rural areas, providing them with free health care assistance. Over 1,000 people living in the Moyamba District benefited from it because it provided surgeries, dental care and examinations to those who needed them. Although the project lasted for only two years, ending in March 2019, a new Mobile Health Clinics campaign began shortly afterward in May 2019 in association with the Sierra Leonean Ministry of Health calling to continue to serve those in need of health care in rural towns.

  3. In March 2019, The United Nations Development Programme distributed 15 vehicles to the Ministry of Health and Sanitation in Freetown, Sierra Leone. Because the country has many roads and other areas that are difficult to travel on foot, the vehicles allow people to deliver health care supplies to those in need more safely and quickly. The United Nations also trained Sierra Leoneanese, including 360 women, in the management of the Health and Sanitation facility. “Health-related issues shouldn’t be restricted to one agency,” said the UNDP’s Resident Coordinator, “there should concerted efforts from all stakeholders. Development starts with healthy people.”

  4. According to the World Health Organization, hand hygiene has served as a major issue within the country. Many people in Sierra Leone do not have access to clean water to wash their hands, which aids in the spread of diseases. In response to this and to support World Hand Hygiene Day each May, Sierra Leone now has handwashing stations near hospitals. WHO has also held events educating locals about the importance of handwashing to keep both individuals and communities disease-free.

  5. In September 2019, Sierra Leone’s government opened Rokupa Hospital in Western Urban District, Freetown, aiming to improve health care services for women and children. An estimated one in 17 women in the country dies due to complications from childbirth and the facility aims to provide women with access to better maternal health care. The hospital has added 4,000 new health care staff and increased the financial investment for health services by 2.1 percent. On top of the Sierra Leoneans government, the U.K. government and the United Nations Population Fund also funded the construction of the new facility.

Sierra Leone may have a long way to go to improve its health care, but its significant progress is impressive. With increased efforts, the country should be able to provide even better care in the future.

– A. O’Shea
Photo: Unspash

Food Insecurity in Sierra Leone

More than 40 percent of Sierra Leoneans experience food insecurity. This largely stems from the nation’s high poverty rate—53 percent of the population lives below the income poverty line—and the fact that 60 percent of the population performs low-paying subsistence agriculture work.

Efforts to address food insecurity in Sierra Leone, including those by the World Food Programme, the International Fund for Agricultural Development and Action Against Hunger, concentrate on combating these root causes and providing food to those in need.

Even though the food insecurity rate in Sierra Leone is still high, it has improved over the last several years, declining from 49.8 percent in 2015 and 43.7 percent in 2018. The percentage of households that are severely food insecure also decreased significantly, falling from 8.6 percent to 2.4 percent between 2015 and 2018. Still, approximately 3.2 million Sierra Leoneans continue to be food insecure and 170,000 are severely food insecure.

Furthermore, malnutrition in Sierra Leone is a persistent problem because of food insecurity. A 2018 survey found that 24 percent of households reported consuming food from less than three food groups in a week. This diet can have a dangerous impact, especially on children as malnutrition affects their physical health and making educational attainment more difficult.  Of note, 31.3 percent of children in Sierra Leone suffer from stunted growth due to chronic malnutrition.

3 Organizations Combating Food Insecurity in Sierra Leone

  1. The World Food Programme
    The World Food Programme (WFP), active in Sierra Leone since 1968, works to provide aid to those experiencing food insecurity and malnutrition, as well as addressing some of the causes of persistent food insecurity in Sierra Leone. Some of the organization’s main goals are ensuring access to food for all, achieving lower malnutrition rates and helping smallholder farmers become more financially prosperous. To accomplish these goals, the WFP provides food assistance to those affected by disasters and emergencies, provides cash assistance to the chronically food-insecure and trains smallholder farmers to strengthen their market access and profits.One of the WFP’s most impactful programs is its school feeding program, which was launched in 2018 in Pujehun and Kamiba, two districts experiencing some of the worst food insecurity in the nation. A significant side effect of food insecurity in Sierra Leone is low schooling rates, especially for girls. To reduce the number of children a family needs to feed, parents sometimes arrange child marriages for their daughters. This effectively ends their education because girls who are married are rarely able to continue going to school.

    Providing meals at school helps encourage families to continue sending their children to school and helps reduce the associated cost for the family. It also ensures vital nutrition and can help reduce malnutrition and its effects, including stunting of growth. The Pujehun District has a stunting rate of 38 percent, one of the highest in the country, which reflects a significant need for a program like this.

    The school meals are not meant to be a substitute for home-cooked food, but they help ensure that children do not go hungry during the day and provide a consistent source of essential nutrients. The school feeding program reached more than 29,000 children, including 14,000 girls, in its first year.

  2. Action Against Hunger 
    Action Against Hunger has been active in Sierra Leone since 1991. Their programming is focused on improving sanitation, hygiene and water access, as well as food security. To decrease food insecurity in Sierra Leone, Action Against Hunger grows leguminous plants and vegetables to help diversify food and income for farmers. They also develop savings and credit groups to increase financial opportunities for smallholder farmers.In 2018, Action Against Hunger helped a total of 215,433 people, 8,000 of which benefited from food security and livelihood programs. They also strengthened 32 health facilities and helped improve nutrition for mothers and children under 5.
  3. The International Fund for Agricultural Development
    In March 2019, the government of Sierra Leone and the U.N. reached a $72.6 million deal to improve food security and rural income in the nation. The International Fund for Agricultural Development (IFAD) is providing a $5.9 million loan, a $5.9 million grant and allocating an additional $40.8 million to use for the deal between 2019 and 2021. The additional funds are being provided by the government of Sierra Leone and the private sector. This project seeks to tackle poverty and food insecurity in Sierra Leone by strengthening agricultural systems and empowering farmers.  Women and youth are hoped to make up at least 40 percent of the project in an effort to promote gender equality and provide opportunities for young people.IFAD will invest in agricultural mechanization, water management and irrigation, as well as create field schools for farmers and provide them with opportunities for greater financial security. The goal is to increase production and expand markets to raise smallholder farmers’ incomes, thereby tackling one of the root causes of food insecurity in the nation.

Sara Olk
Photo: Wikipedia

Community Healing Dialogues in Sierra Leone
There are historical misunderstandings and under-investments in social care for people with mental health problems. This is even more prevalent among people living in poor countries like Sierra Leone. People in Sierra Leone do not treat mental health as seriously as other physical health disabilities. Sierra Leone has a population of more than 7 million people and there are only two psychiatrists, two clinical psychologists and 19 mental health nurses. There are also only four nurses that have specialization in child and adolescent mental health. With a clear need for psychological professional help, there has been a rise in community healing dialogues in Sierra Leone.

Mental Health in Koindu

Like many towns in Sierra Leone, Koindu struggled after the Ebola epidemic. Some say that mental disorders and anxiety affected many citizens even after the virus outbreak. Koindu citizens go through similar psychological effects as war veterans.

After experiencing stigmatization and discrimination from within their communities, many survivors of the Ebola outbreak became stressed which increased mental health problems. Koindu’s community suffered distress with only a few mental health providers and little information about psychological pain. The USAID Advancing Partners & Communities project initiated community healing dialogues (CHDs) to provide care to the people.

Community Healing Dialogues (CHDs)

Trained facilitators lead the community healing dialogues. They unite the community members together to vent their concerns and come up with ways to solve them. The success of community healing dialogues in Sierra Leone is raising awareness about serious problems affecting group members. Community members are discussing economic and livelihood challenges as a group, and creating solutions. People, who formerly discriminated against Ebola survivors, are now accepting them back into their communities.

Once a week, the CHDs gather between 15 to 18 community members to talk about and promote the mental health issues in their communities. There are at least two social workers and two nurses per district to organize and facilitate Community Healing Dialogues. More than 705 community members in 45 communities benefit from this psychosocial care. Depending on the situation, people refer some members to higher-level mental health services.

Higher-Level Program Aid

The World Health Organization (WHO) developed the mental health gap action program (mhGAP) to provide more specialized services. The program trains higher-level health care workers and medical doctors around the country. The workers and professionals use procedures within the program to identify and diagnose possible treatment options for mental disorders.

The African region is widely using mhGAP. It is pursuing professionals who may provide more specialized care at the local recommended hospitals; Kissy Psychiatric National Referral Hospital, Connaught Hospital and Ola During Children’s Hospital. The WHO is collaborating with other partners within the Ministry of Health and Sanitation to provide technical support to continue strengthening mental health services.

There is now a better understanding and acceptance of how to treat mental health within the country. Advanced care solutions along with the community healing dialogues in Sierra Leone are improving the quality of care for the people in need of help.

– Francisco Benitez
Photo: Flickr

UNICEF Soccer AidFor over a decade, UNICEF has hosted its annual Soccer Aid, a charity soccer match featuring both professional and celebrity players to raise money for keeping kids around the world happy, healthy and safe. This year, the match was held in London on June 16, and raised a record-breaking £6,774,764 ($8,577,528.70 USD) in one night alone and £1,000,000 more than last year. The UK public, ITV and STV users all contributed, and the UK government matched each donation up to £3,000,000 to defend play for every child.

Helping Sierra Leone and Zambia

The money raised from the match will support the work of UNICEF to ensure that over 80,000 children in Sierra Leone and Zambia can have a childhood of play. The funding will help to provide lifesaving food, vaccinations, clean water, support for caring for mothers and babies and protect children from violence, exploitation, and abuse.

Sierra Leone’s under-five mortality rate is in the 2nd percentile, having one of the highest infant mortality rates in the world. The many causes of death in children are preventable. Most deaths are due to nutritional deficiencies, pneumonia, diarrhoeal diseases, anemia, malaria, tuberculosis, and HIV/AIDS. Some of the attributable factors include limited access to safe drinking water and adequate sanitation, poor feeding and hygienic practices, and limited access to quality health services.

Zambia is a country with many adolescents. 53 percent of the population is under 18 years old, and many of these children–45.4 percent–are affected by extreme poverty. Almost 65 percent of children in rural Zambia are affected by three or more deprivations: access to nutrition, education, health, water sanitation, adequate housing, and physical and emotional abuse. While the infant mortality rate improved by 37 percent between 2007 and 2014, it is still in the 25th percentile. However, with the help of UNICEF Soccer Aid, these conditions can be improved.

UNICEF’s Impact

UNICEF has worked in 190 countries and territories over 70 years to fight for the lives of children around the world. Through their projects, including child protection and inclusion, child survival, education, emergency relief, gender discrimination, innovation, supply and logistics, and research and analysis, the organization saves the lives of nearly 3,000,000 each year.

UNICEF believes in the power of play and the joy of a carefree childhood. However, millions of children around the world are unable to be included in this objective due to disease, conflict, hunger and poverty.
Through play, children are able to learn how to interact with their peers and learn abstract concepts. Just 15 minutes of play can spark thousands of connections in a baby’s brain, and playing before they enter school has an impact on how they will perform.

Since its first match in 2006, UNICEF Soccer Aid has raised more than £35,000,000 and through projects funded by Soccer Aid and the UK government, they have improved the lives of 2,000,000 children and 903,000 pregnant women.

Over the last 13 years, UNICEF Soccer Aid has been able to change the lives of children by helping them reach their full potential. By bringing people together to watch a match and encourage donations, they are able to change lives in many in parts of the world.

– Alexia Carvajalino
Photo: Unsplash

Child Labor in Sierra Leone
Child labor is defined as work that harms children mentally and physically and deprives them of their childhood. Child labor is illegal in many countries, but some countries have found loopholes in their legal frameworks which enables the use of children in some of the toughest work environments. Sierra Leone‘s minimum employment age is 18, but it lacks the ability to enforce its laws. Here are 10 facts about child labor in Sierra Leone.

10 Facts About Child Labor in Sierra Leone

  1. Child labor affects 72 percent of children in Sierra Leone making the grand total almost 900,000. The children are between the ages of five and 14, and most are young boys. Employers put them to work in alluvial diamond mines and tunnels, which the world knows as the blood diamond industry. They often work in the agricultural industry harvesting coffee, cocoa and palm oil as well.
  2. Since the majority of parents cannot afford to send their children to school due to distance, costs of school uniforms and books, teen pregnancy or fear of sexual abuse from teachers, some parents put their children to work in mines, plantations and farms. In worst-case scenarios, parents may even sell their children into child labor because of poverty.
  3. Children working in diamond mines typically only make $0.15- $0.60 per day if they do not have a contract. If an employer does contract them, a child’s limit is $2.10 per day. They do not fare well as rebel groups own most of these mines and they threaten children with violence if they do not work.
  4. Pools of muddy sludgy water or puddles infest most diamond mines which attract mosquitos carrying deadly mosquito airborne diseases such as malaria. The potential medical complications for these children do not stop there. Many suffer respiratory issues, malnutrition, starvation, headaches, eyestrain, dysentery, dehydration, diarrhea, cholera and sexually transmitted diseases from their involvement in the fishing and mining industries, and sexual exploitation.
  5. The amount of child trafficking, sexual abuse and rape in Sierra Leone has provoked President Julius Maada to declare that Sierra Leone is in a state of emergency. In 2018, people reported 8,500 instances, and a third of these cases involved minors. Sierra Leone’s First Lady and other activists have suggested that that number may be higher because people do not report all instances.
  6. Sierra Leone’s economic growth heavily depends on diamond mining, which amounts to approximately half of its international exports.
  7. In the year 2013 and 2014, Tulane University’s study determined that there was a 51 percent rise in the illegal use of children working in the cocoa industry. Child labor drives the cocoa industry not only in Sierra Leone but also Cameroon, Guinea and Ghana. Some industry members claim that approximately 99.5 percent of child labor happens because of families rather than large corporations.
  8. Many disadvantages plague the process of bringing perpetrators to justice. Once a case enters to the criminal justice system for further exploration, they do not resolve. In 2017, Sierra Leone’s government identified 34 victims of sex trafficking and it did not bring the culprits forth to justice.
  9. The National Child Rights Bill has been working hard since 2007 to exterminate child trafficking, early marriages for children and enlistment in armed forces to name just a few. It has done this by providing a framework for how to care for children.
  10. Children enlisted in labor often emerge with psychological illnesses due to danger and abuse. Mental disorder is often associated with disgrace or dishonor in Sierra Leone which affects all child laborers seeking help or guidance. Lawfully adequate mental health care services are tremendously scarce resulting in a 99.8 percent treatment gap.

Hope for Lives

Ending child labor in Sierra Leone will take more than just a village. Thomas Bobby Smith, a Sierra Leone native, founded Hope for Lives, a successful nonprofit. This organization delivered seven donated hematology and immunoassay machines to a local clinic and installed them. In 2013, it revealed the Hope for Lives Library at St. Anthony’s Primary School in Sierra Leone’s capital, Freetown. The library included 15-20 computers, open to 3,000 students upon fair rotation. It also offered constant computer lessons taught by a tech leader and computer and printing services for public use. Hope for Lives is doing all it can to give Sierra Leone’s children and youth options for success. Thomas Bobby Smith kept his momentum strict and faithful by sending another 50 computers to Sierra Leone’s remote areas in hope of creating successful computer labs.

The implementation of the National Child Rights Bill and work from Sierra Leone’s very own President, Julius Maada, are making strides to end child labor. Organizations like Hope for Lives should help revitalize the spirits of children and youth as well.

– Niesha Braggs
Photo: Flickr

Eight Facts About Education in Sierra Leone

Situated towards the bottom of the bulge on Africa’s west coast, Sierra Leone sits on top of one of the most concentrated gold and diamond deposits in the world. But the country’s history as a prime subject of colonialism’s horrors explains why it consistently ranks as one of the poorest in the world. Here are eight facts about education in Sierra Leone that help gage context for the country’s current state of affairs.

8 Facts About Education in Sierra Leone

  1. Poor Education Statistics- As is typical in low-income communities, the country, now with a population of more than 7.5 million people, yields unimpressive statistics when it comes to categories such as enrollment, completion and literacy. A 2016 UNESCO report found that only 47 percent of all primary school students progressed to their last year, which is the American equivalent of fifth-grade. However this social problem is well recognized, and the country’s most recent president-elect, Julius Maada Bio, even incorporated it as one of the pillars of his campaign.
  2. Recent Switch in the System- In 2017, Sierra Leone switched its education structure from a 3-6-3-4 system. The current Sierra Leonean educational system now operates under what is known as a 6-3-3-4 structure. This means that a student’s “complete” schooling is broken into four parts: six years of pre-primary school, three years of junior secondary school, three years of senior secondary school and four years at a college program.
  3. Testing into Higher Education- Students face obstacles along the way through their education, as after the first nine years, which are compulsory education, they must take a Basic Education Certificate Examination which determines who can proceed to senior secondary school. Students that pass this test must take an additional test following their completion of senior secondary school: the Senior Secondary School Certificate Examination.
  4. The Difficult BECE- This exam carries extreme importance, as its passage is necessary to be granted a spot in the Sierra Leone university system. Moreover, in 2011, only 47 percent of test-takers passed. Although alternative routes, such as trade schools, have been set in place to provide pathways for students that fail to reach this point, a general lack of funding towards them has resulted in their deterioration.
  5. New President Dedicated to Improving Education Standards- Bio’s election in 2018 meant a leadership transition from the All People’s Congress (which had been in power for the previous 10 years and had been consistently accused of corruption) to the People’s Party. In an article, the online publication Theirworld described his campaign as “tumultuous,” insinuating that the turnover was far from smooth. Despite this, Bio has since lived up to his campaign promises regarding education and is paving the way for better academic opportunities for future Sierra Leoneans.
  6. Free Education for Primary and Secondary Students- Bio recently launched a program that grants free education to the more than 1.5 million primary and secondary students in Sierra Leone, a move that holds tremendous implications towards reducing the country’s socioeconomic bias towards education completion. He also nearly doubled the country’s education budget, raising it from 11 percent to 20 percent of public spending. With the implementation of affordable education, Bio hopes to combat the low school enrollment and completion levels that have traditionally plagued the country.
  7. Free Teacher Training- The new education plan also includes increased attention to teachers across the country. The teacher competency rate currently hovers below a mere 50 percent across the board for all levels of education. Bio addresses this in his program by making teacher-education free and by opening teacher training campuses which are fairly distributed across the country.
  8. World Bank’s Positive Involvement- The last of these eight facts about education in Sierra Leone is that the World Bank is actively involved in the establishment of new programs working to remedy the aforementioned institutional problems with education. Their recent program labeled the “Revitalizing Education Development in Sierra Leone Project” has funneled $31.37 million into the education system since 2016. The fruit of this is the Performance-Based Financing (PBF) plan, where schools receive higher government grants funded through the World Bank based on “key contributors to school effectiveness”. These include student attendance, reading proficiency and school management practices. The PBF program enforces good educational practices, which in turn benefits the entire learning environment.

Even with all these improvements, it must be noted that Sierra Leone still faces significant gender discrimination in its education system, as women are currently significantly underrepresented. For instance, in 2015, the male literacy rate almost doubled the female literacy rate for the population aged 15 or older.

However, hopefully, the trend of inclusion rooted in uniform equity being promoted by Bio will soon extend to all people, especially those historically excluded. His sentiment is echoed in his own words as he said during his campaign, “Education is a fundamental right for all Sierra Leoneans.”

– Liam Manion
Photo: Global Partnership

Hepatitis B in Sierra Leone

The Hepatitis B virus (HBV) is the leading cause of liver disease. An estimated 248 million people are infected with the virus worldwide. HBV contributes to 600 thousand liver disease-related deaths a year. It is most prevalent in the Western Pacific with 6.2 percent infection rate and African regions with 6.1 percent of the population are infected. Instances of Hepatitis B in Sierra Leone are high, so the government is working to improve access to vaccinations.

Hepatitis B in Sierra Leone

Sierra Leone suffers an especially high prevalence of Hepatitis B. An estimated 8 percent of the population is actively infected, and 6-11 percent of mothers risk passing the disease onto their children through birth. HBV is most often transmitted via childbirth. It can also be transmitted through exposure to infected blood. In highly endemic areas, this occurs most often before age five. Adults can become infected through exposure to any infected body fluids, including through sexual activity.

Typically, the older an individual is at the time of exposure, the less likely the disease is to become chronic. However, children under a year old are 80 to 90 percent likely to develop chronic HBV if exposed, 30 to 50 percent before age 5 and fewer than 5 percent in adults. There is no cure for the disease, which often manifests without symptoms at initial infection. However, those suffering from it can suppress the virus through life-long treatment.

However, the HBV vaccine is 98 to 100 percent effective and has been shown to significantly decrease a country’s HBV prevalence when systematically administered. Sierra Leone has made a push toward improving its national health through international efforts. Though it is limited in its own resources, the country has facilitated “free testing, treatment and counseling” provided through the help of international donors.

Efforts to Reduce Hepatitis B in Sierra Leone

In 2014, the African Regional Committee of the World Health Organization passed a resolution to reduce HBV prevalence in children under 5 years old by 2020 to less than 2 percent. In 2007, Sierra Leone introduced HBV in the vaccine to newborns at week 6, 10 and 14, but the WHO recommended birth dose was not being given.

Much of the efforts on studying hepatitis B in Sierra Leone have been focused on providing accurate information on its epidemiology. The Center for Disease Control conducted a survey measuring the frequency of mother-child transmission and the effectiveness of the current immunization program. Data recently collected on 3,158 households in three provinces of Sierra Leone. Over the course of six weeks, 551 samples of serum were collected

This information will be used to inform Sierra Leone’s Ministry of Health and Sanitation on the success rate of the vaccination campaign. It will show how well the WHO recommended birth-dose works in reducing Hepatitis B. The research also compares Sierra Leone’s mother-to-child infection rate with that of other African countries with similar strains of the virus. The information is expected to be released by the end of 2019.

Areas to Improve

There are still many areas to cover. While the country focuses on expanding the vaccination program, there have been little effort put towards the prevention of adult to adult transmission. Some studies have shown that many healthcare workers lack adequate knowledge of the disease. At least 77 percent of healthcare staff were unable to recognizing clinical symptoms following infection. These areas need to be addressed in order to effectively reduce tranmission of the virus.

Still, the country has made massive strides in improving its HIV and malaria treatments in the past. Now, it must focus treatment on Hepatitis B in Sierra Leone. Education and vaccinations are essential to reducing the spread of the disease.

Katie Hwang
Photo: Flickr

Mental health in Sierra LeoneSierra Leone is a West African country bordered by the North Atlantic Ocean. It is an impoverished country with almost half of the working-age population involved in subsistence agriculture. Between 1991 and 2002, Sierra Leone was subject to a civil war that resulted in more than 50,000 deaths. Sierra Leone also experienced a harsh Ebola outbreak in 2014 that outclassed all others. Its citizens are still recovering from these events, which have resulted in years of physical and emotional pain. This has left hundreds of thousands of people plagued with mental health issues in Sierra Leone.

Mental Health in Sierra Leone

The World Health Organization approximates that 10 percent of Sierra Leone citizens are facing mental health problems. This number may be even higher when taking into account cases that have not been officially reported. “[D]aily hardships and misery can turn into what scientists call “toxic stress” and trigger or amplify mental health problems” as a result of living in extreme poverty. For a long time, there was a lack of political support for mental health in Sierra Leone.

Resources are a big problem when tackling the issue of mental health in Sierra Leone. There are only “two psychiatrists, two Clinical Psychologists and 19 Mental Health Nurses” in a country of seven million people. Furthermore, only four nurses are trained to work with children with mental health issues. Due to the absence of support, many citizens seek out help from the traditional healers available.

Many individuals and organizations are working together with the goal of improving mental health in Sierra Leone. Two organizations that have made significant efforts and progress in raising awareness or providing direct aid to mental health services are the Ministry of Health and Sanitation (MOHS) and the World Health Organization (WHO). Both WHO and MOHS have worked together on projects that have greatly improved support for mental health in Sierra Leone.

The Ministry of Health and Sanitation

Most of those infected or family to those infected during the Ebola virus disease (EVD) outbreak experienced trauma. Patients were often isolated from loved ones and surrounded by strangers. People had to cope with the death of family members and friends. Survivors of EVD beat the virus, but they still experienced toxic stress, depression, insomnia and anxiety. MOHS developed a plan for providing mental health services by improving community awareness, building demand for services and improving access to specialized healthcare workers at all levels of care.

The MOHS worked with the Advancing Partners program on a two-year project funded and managed by USAID’s Office of Population and Reproductive Health and implemented by JSI. In Sierra Leone specifically, MOHS’s framework is being used to aid Sierra Leone’s government with the implementation of health service in post-Ebola recovery. The program is improving mental health awareness in the community, training healthcare workers with the skills to provide high-quality care and reinforcing mental health governance.

So far, MOHS and Advancing Partners have created community healing dialogue (CHD) groups. The groups help communities by providing coping mechanisms, finding resources and offering support for those with psychosocial issues. These groups are placed in areas with a large amount of EVD survivors and trained mental health staff. The CHD groups have “reached almost 700 people in 40 communities across the six districts most affected by the Ebola outbreak (Bombali, Port Loko, Kailahun, Kenema, and Western Areas Rural and Urban).”

The World Health Organization

The World Health Organization is focused on training healthcare workers in Psychological First Aid and the identification of distress. WHO developed the mental health gap action programme (mhGAP) to train community health workers and medical doctors in Sierra Leone. This way, healthcare workers will be able to more easily identify mental disorders and discover treatment options. WHO wanted to create an approach that aims to support mid-level and higher level healthcare workers to provide better tailored services.

Sierra Leone was previously a country where mental health needs were not addressed. The country continues to be impoverished since a large part of its population is unemployed. It experienced devastating losses in its 11-year-long civil war and was further distressed by the severe Ebola outbreak in 2014. The country has a large amount of people still suffering from past issues. That suffering went untreated for a long time. However, organizations like the WHO and MOHS have made considerable progress in addressing the mental health in Sierra Leone.

Jade Thompson
Photo: Flickr

 

improvingsierraleonesurbanmobilitySierra Leone is a country in Western Africa that borders the North Atlantic Ocean. It contains four pronounced physical regions: the coastal swamp, the Sierra Leone Peninsula, the interior plains and the interior plateau and mountain region. Currently, about 62 percent of people in Sierra Leone live in a rural area. These villages center most of their economic activity around rice farming while Sierra Leone as a country obtains most of its economic growth through mining, primarily iron ore. By improving Sierra Leone’s urban mobility, the country will be able to increase its economy.

Many of these villages, as well as the country itself, are still recovering from the civil war that dismantled many of their institutions. In the 1980s, the government of Sierra Leone initiated a program to modernize their road system, which had been used as a railway until 1975. However, the new road system was also a victim of the aforementioned civil war. Organizations like the World Bank are improving Sierra Leone’s urban mobility by improving infrastructure.

The Integrated and Resilient Urban Mobility Project

On June 13, 2019, The World Bank introduced the Integrated and Resilient Urban Mobility Project for Sierra Leone. Their objectives are to “improve quality public transport, address climate resilience, improve road safety in selected areas and enhance institutional capacity in the transport sector.” The Integrated and Resilient Urban Mobility Project is comprised of five main sections:

  1. Modernization and Professionalization of Public Transport Services: This section will “focus on Maximizing Finance for Development (MFD) in the sector”: This section will include a bus fleet renewal scheme with private operators in order to make improvements upon the current informal operator system as well as a bus to school program. The World Bank will be providing technical assistance to strengthen the Sierra Leone Road Transport Corporation, improve capacity building and training for transport operators and install ancillary facilities.
  2. Strategic Resilient Mobility Investments: These investments will be used to “improve access, climate resilience and road safety.” With this section, the World Bank hopes to improve the connection to international markets and the ferry for pedestrians and vehicles. It also plans to improve road conditions, drainage capacity, traffic management, signalization, parking and more while taking into account the country’s strategic city plans.
  3. Building Human Capital and Institutional Capacity: Here, the aim is “to promote public transport reform and operationalize the MFD agenda.” This section focuses on enhancing logistics and strategies for the country in the long term. The World Bank plans to improve road safety and road safety databases, enhance climate resilience by assisting pre-existing sectors as well as improve academic capacity, women’s empowerment and citizen engagement.
  4. Project Management: This sector aims to improve funding for “goods and services to support project management, financial auditing, data collection, monitoring and evaluation (M&E) and operating cost.” This section will also aid in refining project management, social and environmental safeguards, grievance redress mechanisms, response to sexual exploitation and abuse efforts and mitigation of gender gaps.
  5. Contingent Emergency Response Component (CERC): CERC will “enable the rapid reallocation of funding among project components following an emergency.” With a CERC, the World Banks hopes to strengthen disaster preparedness, both natural and manmade, and strengthen the response to conflicts, epidemics and economic shocks.

The Freetown Urban Transport Authority

One way to improve urban mobility in Sierra Leone is by improving infrastructure in the country’s capital, Freetown. The World Bank is working with Adam Smith International, an award-winning global company that specializes in the delivery of projects that improve economic growth and government reform initiatives. They created a six-month project in line with the current Integrated and Resilient Urban Mobility Project, which will improve urban mobility.

Together, they developed a fully integrated mobility plan that updates regulation and planning in the urban center of Goderich and Hastings. It will work to create the Freetown Urban Transport Authority. They are working to rebuild and refurbish new and existing infrastructure to make it more sustainable and improve the roads in Freetown, the Capital of Sierra Leone.

As a country with an initially weak infrastructure and poor economy, Sierra Leone has struggled to adapt its foundation to modern needs. As a country with a higher percentage of rural areas than urban, Sierra Leone has had trouble with their transportation system. However, organizations such as the World Bank and Adam Smith International are working towards improving Sierra Leone’s urban mobility in order to provide more functional and safer streets and easier access to economic and travel centers.

Jade Thompson
Photo: Flickr