Mary Robinson visits Sierra Leone

Mary Robinson, President, Realizing Rights, Rosann Wisman, Director, Ministerial Leadership Initiative for Global Health (MLI), Michelle Bologna, Associate Director, Women Leaders Intercultural Forum (WLIF), Realizing Rights, and Jennifer Magalong, Program Associate, Realizing Rights/MLI, traveled to Sierra Leone from 27-30 July 2010. The team traveled to Freetown, where they visited health facilities and met with government officials and representatives from the NGO community to discuss maternal and reproductive health and family planning.

The objectives of this visit were to:

• Advance a holistic and human rights based approach to addressing maternal health
• Recognize the progress that Sierra Leone has made in establishing free health care to address maternal mortality
• Give visibility to continuing challenges and priorities in addressing maternal mortality and expanding access to reproductive health care and family planning
• Recognize the collaboration that Realizing Rights, through the Ministerial Leadership Initiative for Global Health (MLI), has with the Ministry of Health and Sanitation
• Recognize the work of Concern Worldwide in Sierra Leone, particularly related to Gender-Based Violence

This visit was co-sponsored by the Ministerial Leadership Initiative for Global Health (MLI), a program of Realizing Rights and Aspen Global Health and Development, Concern Worldwide, and the Embassy of Ireland in Sierra Leone.

To view a detailed schedule of events for Mary Robinson’s visit, please see here.

Background

In Sierra Leone, the Ministerial Leadership Initiative for Global Health (MLI) is helping the Ministry of Health and Sanitation (MoHS) to increase its capacity to utilize government and donor funds more effectively and with greater accountability, as well as strengthen the MoHS’s financial management system to increase capacity to more efficiently generate the information required for decision-making. In addition, MLI is helping the Ministry to harmonize development assistance, moving toward a Sector-Wide Approach, an IHP+ Country Compact, and potentially a pool funding arrangement. In light of the government's recent launch of Free Health Care for Pregnant Women, Lactating Mothers, and Children Under the Age of Five, MLI has also been providing technical assistance to improve Ministry leaders’ ability to communicate their priorities and describe their work to government and civil society stakeholders, particularly around the launch of Free Health Care for Pregnant and Lactating Mothers and Children Under the Age of Five. Furthermore, MLI is supporting the development of a policy/advocacy strategy to increase support for family planning amongst major decisionmakers and integrate family planning policy into broader development and health policy making within the government. (For more detailed information on MLI’s work in Sierra Leone, please see here.)

Visit Summary

Tuesday, 27 July 2010

• Courtesy Calls (Ministry of Foreign Affairs, Ministry of Agriculture, and Office of the Vice President)

The visit began with a series of courtesy calls with representatives of the Government of Sierra Leone. Mary Robinson, Rosann Wisman, Anne-Marie Callan, Aminata Kanu, and Sospeter Baitwa had an opportunity to meet with the Honorable Alhaji Ibrahim Ben Kargbo (Minister of Information and Communications), the Honorable Sulaiman Turay (Ministry of Foreign Affairs & International Cooperation), and H.E. Alhaji Chief Samuel Sam Sumana (Vice President).

Hon. IB Kargbo gave Mary Robinson a brief view on the matters of policy and actions of Sierra Leone’s government. His focus was mainly on the education white paper that was scheduled to be released on Thursday (29th July 2010). In this white paper, an extra year of schooling will be added, girls studying sciences with good grades will automatically get a government scholarship for secondary school and if they continue into higher education (studying science) they will receive a further government scholarship for university costs. He also discussed Sierra Leone’s agricultural sector.

H.E. Vice President Sam Sumana discussed the status of the Free Care Initiative. He called upon other African countries to implement similar free care policies, as Sierra Leone sees a great deal of cross-border “health tourists.” He noted that there is a great deal of political will around health-related issues, citing the President’s request for a daily brief on progress in the health sector. There are a number of issues to be dealt with, including financial management and aid effectiveness.

• Dinner Meeting (United Nations Integrated Peacekeeping Office in Sierra Leone – UNIPSIL)

The Hon. Michael v. den Schulenberg, United Nations Executive Representative of the Secretary General (ERSG) hosted a dinner for representatives of the Government of Sierra Leone and the NGO community. Remarks by Mary Robinson, H.E. Dr. George John Komba-Kono (Minister of Health, Office of the Vice President), and H.E. Soccoh Kabia (Ministry of Social Welfare and Children’s Affairs) were followed by a lively discussion. Dinner guests emphasized the importance of family planning, in particular the renewed focus on adolescent girls, as well as health workforce issues.

Wednesday, 28 July 2010

• Site Visits (Grey Bush Clinic and Princess Christian Maternity Hospital and Ola During Pediatric Ward)

On Wednesday morning, Mary Robinson and the Realizing Rights team visited a community health clinic in the Grey Bush slum area and Princess Christian Maternity Hospital (PCMH) and Ola During Children’s Hospital. They were accompanied by H.E. Khadija Sam-Sumana (Wife of the Vice President), Dr. SAS Kargbo (Head of Reproductive and Child Health), and Dr. Alhassan Seisay (Deputy Chief Medical Officer).

During these visits, Robinson met with patients, staff, and hospital administrators, who shared their thoughts on the state of Sierra Leone’s health system and the impact of the recent launch of the Free Care Initiative. Robinson congratulated staff at each of the health facilities for their ongoing commitment to providing quality health care to the women and children of Sierra Leone.

Addressing the media at PCMH, Robinson noted, “In spite of the challenges and pressures on the health system, I am delighted to see the incredible work of the health workers at Grey Bush community health clinic. I am also very happy to see the collaboration between an NGO like Concern and the health facility staff to train traditional birth attendants and establish a pregnant women’s support group to educate women about pregnancy and care at birth, HIV AIDS, family planning and nutrition.”

• Lunch (hosted by the Embassy of Ireland at Country Lodge)

The Embassy of Ireland hosted a lunch meeting for Mary Robinson and representatives of the diplomatic community in Sierra Leone.

• Roundtable: Promising Practices and Ongoing Challenges: A Holistic and Rights-Based Approach to Reducing Maternal Mortality and Increasing Access to Reproductive Health (Taia Resorts)

The Ministerial Leadership Initiative for Global Health (MLI) and Concern Worldwide co-hosted a roundtable discussion on positive developments and ongoing challenges related to maternal and reproductive health care, including family planning. Over forty high-level representatives from the Government of Sierra Leone, development partners, and the NGO community were in attendance. (To view a detailed agenda for the Roundtable, please see here.)

Welcoming remarks were made by Hon. George John Kombo Kono, (Minister of State, Office of the Vice President).

Mary Robinson, who chaired the roundtable discussion, noted that access to health is a human right. She described the visible progress that she could see since her visit to Sierra Leone during the civil war in 1999. She acknowledged that the data for women was still grim and called attention to the statistic that one in every eight women dies in childbirth in Sierra Leone. She congratulated all those present for their role in the launch of the Free Care Initiative for Pregnant Women, Lactating Mothers, and Children Under the Age of Five and noted that it is just one part of a broader effort to improve women’s health. She also noted the importance of the leadership of the President and Vice President in this process and how critical political will is in shaping policy reform.

The Roundtable featured presentations on the following:

• The status and sustainability of the Free Care Initiative for Pregnant Women, Lactating Mothers, and Children Under the Age of Five: Dr. Alhassan Seisey, Deputy Chief Medical Officer, Ministry of Health and Sanitation; Dr. SAS Kargbo, Director, Reproductive and Child Health Programme, Ministry of Health and Sanitation.

• Initial findings from the joint MLI/Concern study on the role of the private sector in reducing maternal mortality and providing access to reproductive health and family planning services: Dr. Rajeev Vishwakarma, National Health Advisor, Concern Worldwide.

• Addressing key barriers to reproductive health and family planning services: Mr. Mahimbo Mdoe, Country Representative, UNICEF; Mr. Sebastien Barraud, Country Director, Marie Stopes.

Key Areas of Discussion:

- Health has been identified as a major priority of the Government of Sierra Leone. The government recognizes the importance of the health sector and the need to address grim health indicators, particularly Sierra Leone’s maternal mortality rate. There is a strong health component of the “Agenda for Change,” (Poverty Reduction Strategy Paper 2). The Ministry of Health and Sanitation now has 74 programs, as well as a National Strategic health Plan. The Ministry remains committed to achieving the Millennium Development Goals (MDG’s) by 2015.

- The launch of the Free Care for Pregnant Women, Lactating Mothers, and Children Under the Age of Five on 27 April 2010 was a significant step in reducing barriers to health care. The Government has demonstrated its commitment to improving maternal and child health, and the health workforce has met the increased demand for services with courage and dedication. Now at the three-month mark, the Free Care Initiative is seen as a monumental example of how political leadership – from the President and Vice President to the Ministry level – can shape policy reform.

- The Free Care Initiative demonstrated progress in increasing access to health services and prioritizing the needs of women and children. However, the Free Care Initiative is just one small part of a larger effort to improve health outcomes in Sierra Leone. The government and its partners must now work to ensure quality of care and the capacity of service delivery by addressing issues of infrastructure, human resources for health, drug procurement and delivery, and accountability. The Ministry is launching the Basic Package of Essential Health Services (BPEHS) in order to ensure quality and access.

- An expanded focus on family planning availability is critical to reducing maternal mortality in Sierra Leone. This focus should include the social and cultural practices that can sometimes create barriers to access for women, such as age of marriage and basic rights of women and girls. Religious leaders and broader civil society leaders must be engaged in this dialogue.

- It is essential to employ a holistic and human rights approach to improving health outcomes. In order to remove barriers to access, stakeholders must address issues of nutrition, education, gender-based violence, immunization, adolescent girls, and socio-cultural practices such as the age of marriage and religious traditions. In order to achieve sustainable results and successfully reduce the maternal mortality rate, the Government of Sierra Leone must engage with religious and cultural leaders around issues of family planning and reproductive health.

- While progress is being made and the trends are going in the right direction, international eyes are on Sierra Leone to see how the Free Care program is managed and what efforts and systems can be put in place to financially sustain the program and to ensure health care for women. The government has demonstrated that they can implement major health reform. Now the challenge will be ensuring quality, access, and long term financial sustainability. Sierra Leone should take pride in what has been accomplished through leadership and collaboration, particularly with the government and development partners. The same focus that brought about this major health reform of the Free Care program needs to be applied to ensuring full and holistic approach to health care can be realized as a basic human right.

• Reception (Country Lodge)

Concern Worldwide and the Embassy of Ireland hosted a Reception in honor of Mary Robinson. Gender-based violence and human rights were the primary topic of discussion throughout the evening. During her remarks, Robinson highlighted the tremendous progress that Sierra Leone has made since her first visit to Sierra Leone in 1999 as UN High Commissioner for Human Rights. She noted that during her last visit, she signed the Human Rights Manifesto of Sierra Leone, which reaffirmed Sierra Leone’s commitment to the promotion of human rights, in particular the rights of women and children. The human rights community in Sierra Leone, led by the Human Rights Commission, has made tremendous progress in promoting gender equality and advancing issues that affect women and children. Significant challenges remain, particularly in addressing gender-based violence, a human rights issue that has tremendous impacts on health, economic productivity, and poverty.

Thursday, 29 July 2010

• Mano River Union Regional Conference (Miata Conference Center)

The Mano River Union Regional Conference brought together representatives of the Government of Sierra Leone – including the Vice President, the First and Second Ladies, the Minister of Defense, and the Minister of Social Welfare and Children’s Affairs – and other Mano River countries and the NGO community. The focus of this conference was on women, peace, and security, in particular in advancing the implementation of UNSCR 1325 in the Mano River Union.

• Meeting with H.E. President Koroma (State House)

Mary Robinson, Rosann Wisman, Michelle Bologna , Anne-Marie Callan, and Sospeter Baitwa, Acting Country Director, Concern Worldwide, Sierra Leone, had an audience with H.E. President Ernest Bai Koroma on Thursday, 29 July. H.E. President Koroma noted that the lack of access to health care was due in large part to lack of money, and that women and children could lose their lives for the sake of Le 30,000 (the equivalent of less than USD 10). Sierra Leone is exploring the possibility of pool funding, looking at the examples of Liberia and other countries. President Koroma reaffirmed the government’s commitment to addressing Sexual and Gender-Based Violence and implementing UNSCR 1325. He noted that Sierra Leone would consider twinning with a northern country on the implementation of UNSCR 1325.

He addressed some of the ongoing challenges inherent in the launch of the Free Health Care program, including the need to improve infrastructure, access to drugs and commodities, human resource issues to ensure that service providers are motivated and adequately trained.

He noted that the Free Care program has increased the numbers seeking service and that in response, the government must provide more health service workers, more and higher quality peripheral health units and hospitals, greater communication to ensure access in rural areas, and address issues related to cultural practices and traditions that may create barriers to care. Mary Robinson reflected on her return to Sierra Leone since her visit in 1999 when she was UN High Commissioner for Human Rights. She acknowledged the important and dramatic changes since then. She congratulated H.E. President Koroma on the launch of the Free Care program and noted her very positive visits earlier in the week at the Grey Bush clinic and the Princess Christian Maternity Hospital.

To view a copy of Mary Robinson’s Memo to H.E. President Koroma, please see here.

• Dinner Meeting with H.E. Sia Nyama Koroma (Presidential Lodge)

The First Lady of the Republic of Sierra Leone, H.E. Mrs. Sia Nyama Koroma hosted dinner at the Presidential Lodge. Conversation centered on issues of women, peace, and security and the implementation of UNSCR 1325.

Friday, 30 July 2010

• Breakfast Meeting with ERSG (UNIPSIL)

The Executive Representative of the Secretary General hosted a small breakfast meeting, during which he was able to share his perspective on key issues relevant to the visit and to discuss strategies for moving forward following the visit.

• Courtesy Call with H.E. Sia Nyama Koroma

Mary Robinson began the conversation by commending the progress being made in Sierra Leone and saying that her visit had been positive. The First Lady talked about her work mainly in Mattru, Bonthe district. Bonthe is one of the poorest areas of Sierra Leone. The local hospital’s maternity wards have been refurbished but the rest of the hospital is dilapidated and they are seeking as additional $2M to complete essential work. They are using community sensitization, talking to traditional and religious leaders to enact change in the common practice of births in homes.

The First Lady also talked about her work in education with FLACIS (First Lady’s Attitudinal Change in Schools) to change the attitudes and behavior of young people, especially towards teen pregnancy.