As published in Global Health Magazine, August 10, 2009.

FREETOWN, Sierra Leone - For a moment last week, Health and Sanitation Minister Sheiku T. Koroma was so optimistic - he would usher in an era of free health care for pregnant women and children, battling head-on the world's worst rates of maternal mortality and under-age five deaths. He planned to make a big splash in a press conference in a few days.

But then donors started blasting holes in the Ministry's plan - it wasn't well-thought through, they said, and it could unleash a wave of mothers and children upon health clinics that weren't ready for them.

And so the Minister punted. He asked a technical committee of donors and Ministry staff to revisit the issue starting today (Aug. 10) and then left Freetown for the weekend. I never had a chance to talk to him about the turn of events.

I've been in Senegal and Sierra Leone for the past two weeks as part of a project with the Ministerial Leadership Initiative for Global Health, or MLI. The group's mission is to do something that very few donors groups focus on: paying attention to the inner workings of a Health Ministry and lending a helping hand in issues from money flows to improving reproductive health. It is a program of Realizing Rights, housed in the Aspen Institute in Washington, D.C.

Along with photographer Dominic Chavez, my role was to learn about the challenges and opportunities inside these Ministries and then to tell stories. That was how I found myself at an emergency meeting last Monday (Aug. 3) that included the Minister, his top staff, and a dozen donor representatives.

Minister Koroma said then that the country had to do something dramatic to reduce maternal mortality and the deaths of young children. He said reinstituting a government promise in 2004 - but never followed through - to provide free health care was the right choice. Several donor representatives at the meeting applauded but also on the sidelines quietly began to raise questions.

Those whispers turned into a forceful donor statement on Wednesday that advised against a public announcement of free health care.

To read more about Sierra Leone's work to bring about free health care, please see the original article at Global Health Magazine.