Sierra Leone has one of the worst lifetime maternal mortality rates in the world, at 1 in 8 – compared with 1 in 4,800 in the United States. A government program implemented last year is meant to help address this situation, which Amnesty International calls a “human rights emergency,” by providing free healthcare to pregnant and breastfeeding women, as well as to children under age 5.
Amnesty International has released a report describing serious challenges that still exist for women and girls trying to access this care. They report problems such as a lack of needed drugs; women being asked to pay for drugs and “consumables” such as needles that should be free; poor record-keeping that affects the delivery of care; corruption; and lack of sufficient monitoring and oversight. Women who are denied care that is supposed to be freely provided have no effective means of complaint, as one interviewee describes:
My baby was crying a lot, and had fever. Hospital had no drugs for him. Need to pay money. They chased me away. I don’t know how to complain.
Amnesty International’s report provides several recommendations for improving the health care system and more effectively delivering required care to Sierra Leone’s women, and asserts that it is necessary to address underlying problems beyond access:
It is crucial that authorities are able to respond to lack of facilities, nonavailability of drugs, systematic bad practices, corruption and other challenges. The government must ensure that women are informed of their right to redress and available complaint mechanisms and are able to participate in the monitoring and accountability processes. Monitoring and accountability bodies must have a strong mandate, be adequately resourced and be accessible, independent, and transparent and able to recommend remedies to improve delivery of health services…. [Accountability] requires transforming the underlying, untenable situation that gives rise to widespread maternal mortality, not just restoring a prior equilibrium.
The organization is asking supporters to send a message to Sierra Leone’s Minister of Health calling for actions to ensure that emergency obstetric services are properly provided, health systems and providers are aware of their responsibilities for the free care program, and systematic attention to problems of out-of-stock and diverted drugs.
Further reading: this Washington Post piece from 2008 explores maternal mortality in Sierra Leone.