Mr SENESIE MARGAO. The challenge for nurses and midwives of a government free health care initiative

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1 Inaugural Commonwealth Nurses Conference Our health: our common wealth March 2012 London UK Mr SENESIE MARGAO The challenge for nurses and midwives of a government free health care initiative In collaboration with the 9 th CNF Europe Region Conference Supported by the Royal College of Nursing UK

2 Inaugural Commonwealth Nurses Conference London, United Kingdom March 2012 Theme: Our health: our common wealth Presentation on: The challenges for nurses and midwives of a government free health care initiative in Sierra Leone By: Senesie Margao Sierra Leone Nurses Association

3 Presentation Outline Background of the Free Health Care in Sierra Leone Barriers to accessing health Strategy Role of the association Benefits Challenges recommendations

4 BACKGROUND OF THE GOV T. FREE HEALTH INITIATIVE IN SIERRA LEONE Sierra Leone situated at the west coast of Africa was at the bottom rankings of the Human Development Index with unacceptable maternal and child mortality figures. The lifetime risk of a women dying from complications of pregnancy and childbirth was one in eight. One in twelve children then die before their first birthday and the majority of these deaths are caused by preventable diseases

5 lack of finance Distance/ lack of transport No staff No drugs Beyound the health facility's capabilities Percentage of respondents No health facility/not functioning Barriers to accessing health care. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 88% 6% 2% 2% 1% 1%

6 STRATEGY A strategy was developed by the Government of Sierra Leone and the Development Partners to set out plan on how to jointly implement the National Policy of free health care services for pregnant women, lactating mothers and children under 5 years of age in November This will mean that in 2010 approximately 230,000 pregnant women and nearly one million infants will benefit from free healthcare services.

7 ROLE OF THE NURSES ASSOCIATION BEFORE THE INITIATIVE Represent members at the regulatory and policy formulation body to see that their interest are met and make sure that the public have quality health care services. This has increased the role of nurses in decision making and policy formulation. Previously, nurses acted on policies set by others: today, nurses are encouraged to be active in creating policies. Raise awareness of members on their role especially towards the free health care services and need for continuous professional development (CPD). Promote responsible and effective use of the health care system and public resources by members and engage other sectors in addressing the determinants of health. Negotiate for better condition of service for members.

8 SALARY SCALE FOR NURSES BEFORE AND AFTER THE FREE HEALTH CARE INITIATIVE FOR NURSES Grade Before- take home New take home Percentage salary salary increase 3 MCHA % % 5 SECHN % 6 RN % % % 9 New MD % % , % , % 13 CNO , % 14 CMO ,

9 BENEFITS OF THE INITIATIVE The Free Health Care has clearly increased utilisation of health care services for the target group compared to the period before the initiative, increasing number of children are now utilising health care services, increasing number of pregnant women are now delivering in health facilities and increasing number of lactating mothers are now seeking postnatal care. As a result case fatality rat e among pregnant women admitted at hospitals has reduced by more than 50%. It brought together government, development partners, INGOs, civil society groups and the UN family to work towards achieving a clear and strategic goal. Most nursing personnel, who opted out to other organisation with better economic opportunities have returned.

10 Comparison of the under fives consultation before and during the initiative 102,032 April 09 - Apri 10 April 10 -April

11 Institutional delivery before and during the initiative 10,273 8,600 April 09 -March 10 April 10 -March 11

12 Building of nurses and midwives capacity by CNF/SLNA

13 SALARY SCALE FOR BEFORE AND AFTER THE FREE HEALTH CARE INITIATIVE FOR NURSES Grade Before- take home salary New take home salary Percentage increase 3 MCHA % % 5 SECHN % 6 RN % % % 9 New MD % % , % , % 13 CNO , % 14 CMO ,

14 CHALLENGES FOR NURSES AND MIDWIVES OF A GOVERNMENT FREE HEALTH CARE INITIATIVE Shortage of critical health professionals, especially nurses and midwives. Most health facilities have only one staff, making it difficult to work effective and efficient. Most of the health facilities are still inadequately equipped, thereby adversely affecting the quality of service provided. The Push system rather than the desired Pull system is used thereby leading to frequent stock-out of drugs at health facilities.

15 A Maternal Child Health Aide in an atenatal clinic in a PHU- job pressure

16 CHALLENGES FOR NURSES AND MIDWIVES OF A GOVERNMENT FREE HEALTH CARE INITIATIVE Lack of accommodation for Health staff making it difficult for staff to settle down in their posted locations.( no rural posting allawance or incentives) Chronic shortages of drugs, equipment and essential supplies and logistics; Low staff remuneration and weak personnel management resulting in low motivation and morale Inadequate support and supervision at all levels Traditional Birth Attendance continue to conduct deliveries in their communities.

17 RECOMMENDATIONS There should be immediate actions to scale up production of additional nurses and midwives of all categories to ensure availability of appropriate numbers and adequate coverage of health care services. This should include nurses and midwives advocating with governments and development partners to commit resources. Working conditions including establishment of incentive packages to motivate and retain health workers, including nurses and midwives, require urgent and sustainable intervention by government and partners. Improved conditions should include involvement of nurses and midwives in decision-making structures at all levels of health care. There should be a responsive human resource policies and plans that clearly stipulate the required categories, numbers and qualities (skills) of nurses and midwives to ensure access and provision of quality health care services at all levels. Build the capacity of nurses in collaboration with partners. Train TBA S on early referrals of pregnant women to health facilities and levied penalties to defaulters.

18 GREETINGS FROM SIERRA LEONE