By Umaru Fofana and Karolina Roiha
KOINADUGU, Sierra Leone, 27 October 2009 - Lack of access to affordable health care is one of the major contributing factors to pregnancy and childbirth-related deaths in Sierra Leone.
Several development reports, notably the UN Human Development Index, consistently indicate that Sierra Leone is one of the world's most dangerous places for a woman to be pregnant and a child to be born.
According to the Sierra Leone Multi-Indicator Cluster Survey conducted in 2005, as many as 495 out of 100,000 women die during delivery, while 267 out of 1,000 children die before they turn five. These grim figures are a result of poverty and deprivation, partly caused by the country's decade-long civil war, which destroyed its health infrastructure.
A nationwide assessment of emergency obstetrics and newborn care - undertaken in 2008 by the Ministry of Health and Sanitation, and UN agencies - found that the state of maternity services for labour and delivery was poor throughout the country.
Lack of facilities
This situation results from a serious lack of both physical facilities and human resources. In addition, the fees charged for maternal and neonatal health services are too high.
"When we go to the hospital, we are not treated because we don't have money. If you don't [pay], you will not be given medicine," said one woman in Koinadugu.
"Cost is the most significant barrier to utilization of health services," confirmed UNICEF Sierra Leone's Chief of Child Survival and Development, Dr. Rumishael Shoo.
Urgent need for skilled staff
Another reason for the extremely low utilization of health facilities is a lack of trust in such facilities, as opposed to more prevalent trust in traditional birth attendants.
And the amount of available, skilled human resources and essential equipment is far too small for the needs of the existing health facilities, especially in rural areas. For example, deliveries are performed by trained midwives in only 2 per cent of community health centres, and only 5 per cent of the facilities have paediatricians.
Most deliveries are performed by traditional birth attendants, who are unskilled and do not make timely medical referrals for difficult cases.
"The most urgent need is for staff that can do basic life-saving things such as give injections," said Dr. Shoo.
Lack of ambulance services and a shortage of basic utilities - such as water, electricity and communications systems for referrals - further compound the problems faced by Sierra Leone in treating newborns, especially pre-term or low birth-weight babies.
Response to shortages
In order to support the government in arresting and reversing this trend, UNICEF has built maternity clinics in several undeveloped districts. In addition, it distributes essential drugs and other supplies for obstetric care, and trains health personnel.
UNICEF also supports the delivery of essential preventive and curative health services for children under five years of age and women of child-bearing age.
Finally, UNICEF supports a community-based approach to reducing infant and young child mortality and improving overall child health. Mothers and children receive health and hygiene education, including information about the importance of handwashing with soap, exclusive breastfeeding, nutrition and malaria prevention. Parents learn how to treat infections in newborns and how to respond if a newborn stops breathing.
UNICEF's work to improve maternal and newborn health is expected to save the lives of mothers and their children - and give them a chance for a healthier future.