Civil war in Sierra Leone throughout the 1990s devastated the country’s health sector. Claudius Davis reports on the slow but steady process of rebuilding.

Sierra Leone’s health statistics speak volumes about the damage done by years of conflict. The mortality rate in children under five is among the highest in the world, at 284 per 1,000. Maternal mortality is equally alarming. Diseases like malaria, cholera and respiratory infections have been rampant, and average life expectancy is just 37 years.

Many rural communities have been particularly badly affected, according to assessments carried out by development agency World Vision. One such area is the Bonthe district in the south, where the organisation has been targeting chiefdoms with its Primary Health Care project, which aims to save and improve the lives of almost 100,000 local people through sustainable community-based health care. 

With poor roads and frequent flooding, Bonthe is one of the least accessible districts of Sierra Leone. Most of its health clinics were damaged or destroyed during the conflict. This lack of medical facilities has contributed towards the significant number of pregnant women who have died in childbirth over the years. Traditional birth attendants (TBAs) were available, but lack of training as well as some potentially harmful traditional practices in maternal delivery resulted in high death rates.

Mama Katumu, in her late fifties, has been a practising TBA in Kpandakemoh chiefdom for many years. “I used to let pregnant women deliver on the ground,” she said. “I forced them to push until at times the child suffocated and died, or the woman developed serious medical problems. Sometimes both mother and child would die. Now that I have received this training, I can do much better.”

A total of 222 TBAs have been trained and equipped with kits provided by UNICEF. Maternal and child health initiatives and health education activities have been introduced, including work to prevent malnutrition after weaning and better treatment of diarrhoea. A new immunisation programme has been introduced in collaboration with UNICEF and the Sierra Leonean government’s Ministry of Health and Sanitation (MOHS). As a result, immunisation against diseases like measles has risen from a shocking seven per cent to an encouraging 45 per cent.

The drive to eradicate polio has also continued with great success – during the two National Immunisation Days in March and April this year, 96 per cent coverage was achieved. As one of the first clinics reopened in his chiefdom, the Paramount chief of Kpandakemoh said: “The happiest people on this occasion are the traditional birth attendants who have received their certificates and kits today. This has never happened in this chiefdom. Lack of medical facilities used to cause our women to die during childbirth.”

“It makes the difference between life and death”, added a member of the Imperie Chiefdom Development Committee. Most significantly, the local women themselves agree. “I used to live 23 miles away but when I learned about the new clinic I moved so I could deliver safely,” said Ayie Sama Lengo, who had previously suffered five miscarriages in eight pregnancies. “There is no qualified nurse or clinic in my home town. Here I received prenatal care and vaccines.” Ayie has now safely delivered a healthy baby.

Water and sanitation is another key component of the World Vision project. The years of conflict had left the district without safe drinking water, with traditional hand-dug wells and streams the only sources of water. By the end of July 2000, a total of 89 wells had been rehabilitated and ten new wells completed, with local people trained as chlorinators and pump attendants to handle maintenance of the wells and increase the sense of community ownership of the facilities.

Alice Fatoma, a mother of two children, lives in Talia in Yawbeko chiefdom. As she drank water from the town’s new well, she summed up the difference it has made to her family and community: “We used to fetch water either from the stream or from our traditional wells and we experienced stomach problems. Now we are very happy to have clean water.”

Claudius Davis is Assistant Program Officer, World Vision Sierra Leone.