Upon assuming office in 2007, I promised the people of Sierra Leone and the rest of the world that my administration will create an open and progressive society that will improve the lives of every Sierra Leonean through ideas and action. My promise was not limited to transparency and open government, but included a vow to improve healthcare in Sierra Leone. Maternal and child health morbidity and mortality needed to improve significantly as rates reached 875 per 100,000 and 140 per 1000 respectively. As a country emerging from the ashes of war, moving from emergency and recovery towards sustainable development and prosperity, I believe that it is imperative to invest in the healthcare system and create robust capacity that is responsive to quality, timely and equitable health service delivery for all Sierra Leoneans.

To address maternal, newborn and child health issues including the integration of family planning services in Sierra Leone, I launched the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) in March 2010, and a month later, in April 2010, I ushered in an ambitious opportunity—the Free Health Care Initiative; a system that provides free medical services (treatment and diagnosis) for pregnant women, breastfeeding mothers and children under five years. This system also includes the provision of free drugs and medical supplies to the targeted beneficiaries. As a responsible Government, I am aware that this venture, though costly, is crucial to our life saving endeavors committed to saving the lives of our people irrespective of regional background and status.

The Free Healthcare Initiative (FHI) has improved access to affordable, timely and quality health services, especially for women and children and its impact have been great and amazing.

The Free Health Care Initiative

The Free Healthcare Initiative has become the basis of my Healthcare promise to the Sierra Leonean people and a flagship/ priority in my Government’s development agenda; Poverty Reduction Strategy Paper II (Agenda for Change) 2007–2012. My Government through the Ministry of Health and Sanitation with support from development partners, scaled up Basic Emergency Obstetric Care (BEmOC) and Comprehensive Emergency Obstetric Care (CEmOC) facilities and services, made the integration of family planning a flagship project and increased the salaries of health professionals more than five-fold. We continue to construct, rehabilitate, and upgrade hospitals and health facilities across the nation. In addition, we have embarked on a robust campaign to attract doctors and health professionals, and increase the number of mid-level health professional to remedy the devastating shortage and mal-distribution of health professionals nationwide. Our commitment remains unwavering and the results have been astounding; we have made significant gains resulting in more than a 100 percent increase in under-five consultation, and more than a 150 percent increase in utilization of health care services. During this time we have also increased institutional deliveries by almost 50 percent, family planning services by more than 140 percent and nutrition surveillance and interventions have improved, with more than 65 percent of acute malnourished children identified and receiving therapeutic feeding services quarterly.
Notwithstanding these great outcomes, we have challenges which include: inadequate infrastructure and equipment, breakdown of cold-chain systems, inadequate logistics and staff, especially middle to top-level health professionals, among other challenges. The vision of quality and timely healthcare service delivery for the Sierra Leonean people is entwined in the countries roadmap to prosperity. The health sector - though faced with enormous challenges -is on an upward trajectory toward improved quality and timely healthcare service delivery. Since my re-election in 2012, my commitment is evident in the new Government development agenda; Poverty Reduction Strategy Paper III - Agenda for Prosperity (AfP) and the significant increase in my Government’s budget allocation to health. The AfP symbolizes a promise renewed, a promise to enhance and improve the health of all people; a promise for better healthcare, especially for the most vulnerable groups in Sierra Leone. In renewing my promise in the AfP, I have reinforced my roadmap for a healthier Sierra Leone. This roadmap includes enhancing and expanding the free healthcare initiative, scaling up hygiene and sanitation, establishing innovating financing, which includes moving towards universal health coverage with a basic package of services and tackling the issue of teenage pregnancy using a multi-sectoral approach. The health of adolescents and young people is pivotal to the prosperity of Sierra Leone, so I have made this a new priority in the Agenda for Prosperity (AfP).

Nutrition

My Government is responsive to the needs of the Sierra Leonean people, and we are fully aware of the difficult challenges of food insecurity and undernutrition, especially among the vulnerable sectors of our society. The cry of our children is a concern for all of us, and as a Government, the issue of undernutrition is of utmost priority and one that is included in our national development agenda - PRSPIII (Agenda for Prosperity). I am committed to the improvement of the quality of life for all Sierra Leoneans and my commitment to tackling undernutrition is demonstrated in our membership in the Scaling-Up Nutrition (SUN) Movement and our resolve to addressing key policies and implementation issues related to food and nutrition security.
The nutritional status of Sierra Leonean’s population, though improved slightly over the years, needs significant improvement, because one in every three children under five years is stunted and 76 percent of them are anemic. This is unacceptable. Hunger and malnourishment adversely affects the development of our children, which in turn impedes their ability to contribute to our national development. More significantly, undernutrition contributes to our maternal and child mortality numbers, and impacts the educational pursuits of our children. Malnourished children are likely to be intellectually impaired with diminished productive and creative capacity. This is the stark reality that confronts us as a nation and the reason my Government has acted decisively to decrease the prevalence of undernutrition.

Our efforts have made a significant impact. Key achievements attained to date include a multi-sectoral coordinating mechanism that coordinates multiple stakeholders, including development partners and relevant line Ministries and departments and agencies implementing Government policies and programs. In addition, we are proud of having increased the number of qualified Nutritionists by 150 percent at national and district levels, with each district having Nutritionists that contribute to the implementation of the Free Healthcare Initiative. We have signed a Nutrition for Growth Compact and created a specific budget line for Nutrition in the Ministries of Health and Sanitation, Agriculture and other relevant line Ministries. This is a significant improvement, as nutrition is considered a key component of our healthcare service delivery. I will continue to show leadership on the issue of malnutrition and accelerate efforts in the following areas:
Build the capacity of health Professionals on nutrition counseling, and management of acute malnutrition while also increasing the number of Nutritionists at national and district levels
Reduce the prevalence of stunting from 25.7 percent to 11.7 percent and wasting from 6.9 percent to 2 percent by 2020, while increasing exclusive breastfeeding from 32 percent to 70 percent
Ensure adoption, implementation and compliance with the Breast Milk Substitute Code, maternal leave and food fortification, and finally
Scale up community support network nationwide.

Expansion on the Free Healthcare Initiative (FHCI)

As a way to expand the coverage, scope and breath of services of the FHCI, my Government is exploring the possibility of including disabled persons and victims of gender based violence while potentially increasing child coverage to include some adolescence groups. Additionally, the scope is being expanded to cover other primary health care service such as dental, blood, and eye, nose and throat (ENT) services.

My Government is also working with partners to develop an insurance scheme that will support the principle of social solidarity on one hand while also taking into consideration risk pooling to ensure sustainability of the scheme. A draft blueprint has been developed and discussions are at an advanced stage to agree on the benefit package, institutional arrangement, target groups and funding possibilities.

The road to prosperity could not have been achieved without strong political leadership and a clear vision at all levels of government and its functionaries, including strong alliances and partnership with Health Development Partners. The multi-sectoral approach involving line ministries, departments and agencies such as Health and Sanitation, Education, Science and Technology, Social Welfare, Gender and Children’s Affairs and Youth Affairs is commendable.

Making In-Roads In The Fight Against Teenage Pregnancy

Most recently, in May 2013, I launched the National Strategy for the Reduction of Teenage Pregnancy, a multi-sectoral approach to address the issues of teenage pregnancy and early marriage. The high prevalence of teenage pregnancy is an emerging issue of national concern; one of the more pervasive problems affecting the health, social, economic and political progress and empowerment of women and girls in Sierra Leone. In my second term, I am committed to work with partners and engage all sectors of the population in a nationwide effort to tackle this problem. I am one of the first African leaders to create a multi-sectoral initiative to address the issues of teenage pregnancy and early marriages, and prioritize these issues in my national development agenda. I have mandated the establishment of a National Secretariat to ensure the successful coordinated implementation of the strategy and have anchored this secretariat in the Ministry of Health and Sanitation. The implementation of the Teenage Pregnancy Strategy is holistic. It includes the repositioning of family planning services for teenagers and adolescent girls including women of childbearing age and the re-establishment of child friendly services within health facilities, school clinics and other social opportunities for women and girls of child bearing age. My government is determined to make sure that girls remain girls and not mothers, and that they become productive members of their communities and the country at large.

Social Protection—The Child Rights, Marriage And Divorce Acts

The Agenda for Prosperity includes an entire pillar dedicated to social protection, which is a significant priority in my government. Social protection is not only protecting the girls but also includes facilitating support for girls especially those from extremely poor families. The Child Rights Act and the Customary and Divorce Act, stipulates that nobody should engage the girl child in early marriage. Millions of girls are denied both a voice and choice, and are confronted daily by sexual violence, unwanted pregnancy and child marriage. Many are not able to make the right decision. This is an issue of national concern because it is one of the more pervasive problems affecting the health, social, economic and political progress and empowerment of women and girls in Sierra Leone. In line with the circumstance in question, I pledged to intensify efforts in my second term in office to work with partners and engage all sectors of the population in a nationwide effort to tackle the problem.

Commitment

Despite the numerous challenges in the health sector and the rough path way for the successful and sustainable implementation of the Free Health Care, I firmly and confidently committed Sierra Leone to the launch of the Free Health Care in April 27, 2010 our 49th Independence Anniversary.

My Unwavering Vision And Retirement

After my tenure as President, I will retire in my village and tell the success stories of the policies of my administration and the impact they have had on the lives of all Sierra Leoneans. I will tell the story of endurance, steadfastness and commitment to bring about positive change and transformation in the health sector. I will tell the story of how we created a better future for women and girls, and stopped the vicious circle of children bearing children.

Sierra Leone has begun a remarkable transformation; projects in infrastructure, energy, water, health and sanitation, agriculture, education and the private sector have earned us accolades across our continent. To date, more than 500 development projects have been completed that will improve the lives of Sierra Leoneans nationally. The road to prosperity in Health is one that is achievable for a country with approximately six million people, whose tenancy and drive to reclaim the lost years of war is unwavering. Though not oblivious to the fact that achieving the goal of a middle income country by 2035 will require tackling the challenges that lie ahead as a nation head on; my march towards this vision is unwavering.