How Concern is strengthening healthcare systems with Saving Lives in Sierra Leone 3

Saving Lives 3 is a five-year project funded by the UK government and led by Concern. It is being delivered by a consortium of six NGOs (Concern, Helen Keller International, Humanity Inclusion, Kings Global Health Partnerships, Send Sierra Leone and WelBodi Partnership) across six districts in the country. 

We spoke with Sarah Cundy, Concern’s Health Programme Coordinator in Sierra Leone and the consortium team lead for Saving Lives 3 to find out more about the impact this project will have.  

In Phase 3, our goal is to strengthen the health system in Sierra Leone and improve the quality and quantity of services available. We are addressing this across four areas: district support, community level interventions, health workforce development and accountability, and clinical services.  

We’re focusing on health service delivery, right from people’s households and communities, through to hospitals, and also government policy and guideline development. 

When we look at community level, we’re focusing on how people understand their own health needs and their own health rights, and how they can access those more appropriately and more regularly. So that we’re not only treating disease and ill health, but also working on prevention. 

We are going to be supporting healthcare workers through a clinical mentorship programme. Rather than bringing in a lot of external staff for the programme, the system strengthening component means that we’re using the personnel already available within the health system here, and giving them the skills and logistics they need to support their own co-workers and junior staff. 

At the district hospital level, we’re also supporting blood banks, especially for maternal emergencies and children under five who may need blood transfusions for severe anemia. We're also supporting them with things like fuel, and payments for repairs to water systems, so that they can keep water running to prevent infections and have electricity for essential things, like lights in operating theatres when where they’re conducting cesarian sections. 

 One of the reasons why the need for this programme is so great is that the country has had many shocks to its healthcare system over the years, from civil war to the Ebola epidemic, and then a recovery phase that was interrupted by Covid-19.  

One of the most basic challenges people face is being able to get to a health facility. Although we have a large number of facilities in Sierra Leone, it doesn't mean they’re easy to access. For example, women expecting a baby may have to walk anywhere from two to three hours to reach a health facility and once you’re nine months pregnant, it’s almost impossible to be able to do that. The country’s long and intense rainy season also makes travel more difficult.  

On top of that, you have to know what services are available and when you should access them – what we call health literacy. Knowing ‘I need to get support now’ or ‘I need to see a health provider now’ is one of the other things we’re supporting both the communities and the Ministry of Health to improve on. 

At the community level, one of the exciting things we’re doing is working hand-in-hand with health service providers through backyard gardens. The community will plant the gardens and look after them, and then they’ll join the health facility staff for education talks about nutrition for pregnant women and children under five, and how to appropriately wean a baby using nutritious and locally available foods 

The work we’re doing at the community level for pregnant women should mean that women will have healthier pregnancies through better nutrition and prevention of malaria. Women will be stronger and more well-informed on their pregnancy, so hopefully they can and will access ante-natal care regularly. This adds another layer of preventing what could be fatal diseases, such as tetanus.   

Additionally, a woman will know what to expect when she goes into labour. So rather than thinking she has a stomach or back ache, she knows she needs to go to the health facility. Then once there, it means she’s arriving calmer and not in an emergency, which gives the healthcare workers the opportunity to provide the care and attention they’ve been trained to give to every woman. 

At the policy and government level we are working on some big accountability mechanisms, looking at the entire system, from households and communities, right up to national level.  

That includes a feedback, complaints and response mechanism. This a free phone line where patients, community members or any other stakeholders can call, either to leave complimentary feedback or to raise a concern, and know that somebody within the District or National Ministry of Health will respond to that and take appropriate action. 

In addition, we’re doing a huge amount of work on safeguarding within health services and healthcare ethics, and that’s going to support both our health workers and our service users to have a much more positive experience, which automatically will encourage more people to access those services. 

Ultimately, I hope that we achieve a much lower number of maternal and infant deaths, and that we have much happier and more confident health facility staff. I hope that there’s more trust between the two groups, and that they see each other as partners in healthcare. 

At a national level, I hope that we’re able to recognise the efforts of our health workers, and recognise all the achievements that have been made so far.