Dr. Daoh Photo Credit Dominic Chavez

GlobalPost spoke with two of Sierra Leone’s key health officials, Dr. Samuel Kargbo, director of reproductive and child health and Dr. Kisito Daoh, chief medical officer, about going from a barely functioning health system to the one they have in place now.

Can you explain what health care in Sierra Leone was like before April 27, 2010?

Before we had free health care, people would only come to the hospitals when they were at the point of death and there was virtually nothing that one could do. Hospitals had become kind of like a cemetery. It was almost as though people had come to deposit the body in a morgue.

People were living in places far away from the hospital, and no matter what medication you gave to them, they never seemed to get to the hospital on time. And this was simply because there was no public transportation in those areas.

What were some of the challenges you faced?

As a minister of health, you may be tempted into thinking that if you make a very good hospital, have the best staff, the best drugs, then health will improve. It will not improve. It will only improve if people are brought to hospitals early; people who are brought to hospitals early are saved. But when the roads are terrible, and there is no communication, and women come to the hospitals very, very late, the only thing that you will get is a bad name. Because if you touch every patient that comes in the last hour, what is going to happen is that all of them are to die on the operation table.

A national population survey in 2008 showed that people were not coming to health facilities to access health care. The singular reason that they were not coming to health facilities was because cost was attached. And so, [President Ernest Bai Koroma] announced that cost was removed. When you introduce free health care, you ask the question, why are people charging for health care? The answers are, because the [health workers’] salaries are low. The second thing is that because there isn’t easy access to drugs, the staff has to bring the drugs themselves. So then, you say, if we want to give free health care, we have to give health workers bigger salaries, and then we need to get a system for giving drugs. So, we bought drugs and supplies. Then we realized that because we had not been getting drugs into the system in a formal way, [we] had to put in a logistical system for the supply of drugs.
And then we had absentee workers, people who were working but weren’t on the payroll. And then we had people who were on the payroll, but they were working elsewhere. And then we had ghost workers, people who were on the payroll but no longer worked for us. And so we had a company to come and clean up the payroll, and put in a system of registration.

Q: And successes? 

[Because of the free health care initiative], for the first time in the Ministry of Health, we had implementing partners, the donor community, and the Ministry of Finance, all of us working together to achieve one goal. It was the first time all of us ever came together. This was a tremendous feat.

To continue Dr. Kargbo's interview and to read Dr. Daoh's interview,  please see Global Post's orginal article.