Gaining People's Confidence in Health Care – Sierra Leone

• More than three years after Sierra Leone was declared free of Ebola, people are still reluctant to visit health centers.

• In a country where maternal mortality is among the highest in the world and where children die It still means traveling far and paying expensive drugs and services without any certainty of being cured.

• To gain the confidence of people in the health system, Médecins Sans Frontières (MSF) trains local staff, provides medical stocks and

At 10am, the health post of Konta, in the Gorama chiefdom Mende, in Sierra Leone's Kenema District, is slowly filling up with patients. A row of pregnant women waiting in the maternity ward a lady in pink, Margaret Toka, the nurse of maternal and child health post.

While she is preparing her room for the day's consultations, the women on the outside are catching their breath after a long trip to the health post. Most of them come from Bondayelahuu, a village on the other side of the Sewa.

To get to Konta, they walked for over an hour, crossed the river by canoe and walked another half hour from the crossing point

"It's far, but it's for my baby so I have to do it, "says Bintu Fofannah, the group's youngest. She says she is between 18 and 19 years old and it is her second pregnancy

She gave birth last year but her first baby did not survive. This is the first time she's checked at the health post and she's nervous.

Using rapid diagnostic kits, Margaret will check Bintu's hemoglobin and blood sugar levels, examine it for sexually transmitted infections and perform the mandatory test. Like other women who went for their prenatal visits, Bintu will receive supplements or antibiotics if needed, and a few sets of mosquito nets to prevent him from contracting malaria with his family.

She will be pleasantly surprised to know that she receives all this for free. She just has enough money to pay for the canoe trip home

Health Care After Ebola

Wearing and Delivering a Child Always Poses D & # 39; 39 huge risks for women in Sierra Leone. The country's maternal mortality rate is among the highest in the world

Children under five regularly contract malaria, the leading cause of death in this age group, and many suffer from severe or severe malnutrition. acute.

struck by natural or man-made disasters, as well as by epidemics, which make it difficult to restore the health system after each stroke.

When the Ebola virus hit the country in 2014-2015, the already-limited health workforce in Sierra Leone further decreased by seven percent. In Kenema District alone, more than 200 health workers died of the disease

In rural areas, most peripheral health units have become barely functioning. They are dilapidated, without water or electricity and, most often, they have neither staff nor medical staff.

For some people, getting to the nearest PHU will take about an hour on a motorcycle. They will have to pay a heavy price for the two-way trip only to arrive at a health post that has neither the facilities nor the health workers to treat them.

It is then more convenient for them to stay in the villages and turn to traditional healers, who would accept gifts such as rice or crops in exchange for their services. Local communities have been relying on them for generations.

Early detection and transfer of complicated cases to health facilities is, however, very difficult when deliveries and treatment are done at home, often leading to death. MSF works with the Ministry of Health to prevent women and children from dying from preventable causes. For MSF, it is also a way to strengthen people's confidence in the health system

Konta health post is one of the 10 public health centers that MSF is rehabilitating in the chiefdoms of Konta. Gorama Mende and Wandor, in the north of Kenema district. supply of essential drugs and commodities, including test kits for women and therapeutic food for children.

MSF also upgraded facilities at the Baama Community Health Center, which receives complicated cases from USPs.

An outreach team composed of MSF nurses and midwives works alternately alongside Ministry of Health staff like Margaret to improve practical skills in diagnosis and treatment

criteria, so that they strengthen the confidence and medical judgment necessary to make urgent referrals to Baama or the district government hospital.

In Baama, an ambulance and a fleet of motorcycles are ready to be deployed whenever a pregnant woman or a child under five needs a higher level of care. An MSF team from Kenema District Hospital will follow up referrals, all of whom will be treated free of charge.

"We are working to empower the staff of the Ministry of Health," says Francis Mbuthi, MSF Project Medical Officer. point. "To reduce mortality, they should be able to handle complicated cases, detect and refer cases, and explain to patients exactly what is happening to their health." If staff do not explain them, they will not seek treatment. "

A team of health promoters spread messages about malaria prevention, good hygiene practices, family planning, and teenage pregnancies. 19659005] In addition to community leaders, health promoters also engage traditional healers and traditional birth attendants in community conversations, recognizing their role as first responders to expedite the referral of patients.

Near the Kenema City, MSF is building also a pediatric and emergency obstetrics hospital that will focus on reducing maternal and infant mortality while contributing to development of the country's health workforce.

Pediatric care will be provided at the MSF hospital from the end of the year. unit, an inpatient therapeutic feeding center (ITFC) and a general pediatric ward and an isolation area. The hospital will also have a modern laboratory and a blood bank. Another plan for the expansion of the structure includes a radiology department as well as training centers.

Training human resources is a crucial step in the development of Sierra Leone's health system. A higher number of qualified health workers will improve the services provided in primary health care facilities and enable an effective response to disasters and epidemics.