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Children dying but hope persists

Young mother in Sierra Leone

Health experts in Sierra Leone say the country’s bottom-ranking for child mortality in the UN Children’s Fund’s annual State of the World’s Children report masks progress the country has made in mother and child health in recent years.

Of every 1,000 children born in Sierra Leone each year, 262 will die before age five, and 2,100 women die out of every 100,000 live births, according to UNICEF.

But health experts say despite the alarming statistics, child mortality rates are improving.

In 2000 282 under-fives were dying per 1,000 births, but the latest figures, from 2007, show this dropped to 262, Geert Cappelaere, UNICEF representative in Sierra Leone, told IRIN. And yet-to-be validated figures from a 2008 UNICEF survey indicate they may have dropped further to 200.

”These are not dramatic changes but they show investment is starting to pay off,” Cappelaere said. “We have positive examples of things happening on the ground. We need to have hope for Sierra Leone. It is guaranteed we can [eventually] see a dramatic reduction in child and maternal mortality.”

Change will be incremental says Joanna Reid, Senior West Africa Health Adviser with the UK Department for International Development (DFID). “With Sierra Leone starting so low [in terms of indicators] there is lots to be sorted out before we see more dramatic impact in terms of child mortality indicators.”

Medical officials estimate that 80 percent of women in Sierra Leone give birth at home without ever consulting a healthcare provider or midwife. And as of March 2008 there were only six obstetricians serving the five-million-strong population, according to the UN Population Fund (UNFPA).

Government commitment

UNICEF’s Cappelaere said President Ernest Bai Koroma and his government are firmly committed to improving healthcare. “The President has recognised that investment in health, and within that child survival, is vital to the country’s future growth,” Cappelaere said.

The President launched a ‘strategic plan’ to reduce maternal and child mortality in early 2008 and is mapping out how to achieve the objectives in the next five to 10 years, according to DFID’s Reid.

New mother in Sierra Leone. Sierra Leone has the highest infant mortality rate in the world according to UNICEF's State of the World's Children

New mother in Sierra Leone. Sierra Leone has the highest infant mortality rate in the world according to UNICEF's State of the World's Children...
Thursday, January 15, 2009
Children dying but hope persists
New mother in Sierra Leone. Sierra Leone has the highest infant mortality rate in the world according to UNICEF's State of the World's Children...

Photo: Savage/UNICEF
Sierra Leone's infant mortality rates are dropping, though slowly

“Health will be our top priority in 2009,” Dr. Samuel Kargbo, director of reproductive and child health at the Health Ministry, told IRIN. “The situation has already improved.”

“Since the reproductive and healthcare strategy was launched the government has created a new body to coordinate all reproductive health activities, and has carried out mass awareness-raising of its action plan in each health district.”

Each district is to come up with a health ‘road map’ in 2009, health officials said.

DFID has been working closely with the government to get its strategy off the ground and will invest US$72.8 million in Sierra Leone’s health sector over the next 10 years.

But as with other fragile states emerging from conflict, Sierra Leone’s basic services infrastructure is severely limited and in some areas must be built from scratch.

To do so would require the government to increase funding for the health sector from the current 9 percent of the overall budget to 15 percent, according to Kargbo. “The health budget is a problem, but serious considerations to increase the budget are underway.”

Absorbing the money

But more money is not a panacea, health experts said. Sierra Leone does not have enough people or systems in place to absorb and invest all the money allocated to healthcare, UNICEF’s Cappelaere explained.

In 2008 the government spent just half its health sector budget, partly because of not having basic financial systems in place, he said.

“Systems, infrastructure, the human resources are not always available to do what needs to be done. You may have lots of money but if you have no capacity to deliver it then you have a problem," Cappelaere pointed out.

Weak capacity to channel large investments is typical of post-conflict states, donors say.

The Health Ministry’s Kargbo called on donors to “urgently” help the government map out an approach to health financing.


To reduce infant and maternal mortality, some of the government’s priorities should be to tackle the shortage of skilled health workers, install better medical equipment and medical supplies, set staff incentives and create better patient referral systems, according to Kargbo.

In addition to quality obstetric care and improved water and sanitation, Cappelaere calls for a minimum set of healthcare services for each child – including immunisations, micro-nutrients such as Vitamin A, distribution of insecticide-treated mosquito nets and public sanitation messages, which when combined, could dramatically reduce infant mortality.

“If 95 percent of Sierra Leonean children are immunised against measles for instance, it could lead to dramatic reductions in infant mortality in 10 years,” he said.

“A few generations to change”

Long-term results also require behavior change, including reducing early child marriage, encouraging mothers to exclusively breast-feed their babies for six months and reducing open defecation, according to UNICEF.

“This kind of behavior can take a few generations to change,” Cappelaere said. “Expectations for immediate results may be too high. [Instead], modest, sustainable goals are needed… if it is done too fast it could be counterproductive.”


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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