Health in Sierra Leone: A Diaspora Intervention M eeting Summary - - PDF document

Health in Sierra Leone: A Diaspora Intervention M eeting Summary Report

M ay 9

th 2009

Sir David Davies Lecture Theatre, University College London

Summary Report by the Sierra Leone Diaspora Network (SLDN)

SLDN is supported by

Overview

The Sierra Leone Diaspora Network (SLDN) hosted a meeting for invited Sierra Leonean health professionals in the UK and mainland Europe on May 9

t h 2009. This meeting was designed with the overall

aim of bringing together medical professionals and stakeholders in a forum to discuss how best Diasporans can support developments in the health sector, and in addition, to meet the following objectives: To mobilize the Sierra Leone health community in the Diaspora, with a view to harnessing current efforts so as to encourage a more coordinated approach to health intervention in Sierra Leone; To facilitate discourse between Diaspora health professionals and Sierra Leone government health representatives, so as to assess the health priorities on the ground and Diaspora can support government strategies; To conduct a skills audit and to facilitate a live and active forum where Diaspora health professionals (global), the M inistry of Health in Sierra Leone and other partners working in health roles in the UK and Sierra Leone can meet to explore opportunities of working together for the benefit of the health of Sierra Leoneans; To present a comprehensive Volunteering Package for Diasporans, inclusive of flight, accommodation and travel in Sierra Leone. Chaired by Victor Mengot, the conference was divided into two sections: The morning sessions assessed the current state of health within various sub-sectors in Sierra Leone, the needs and how the Diaspora can meet the shortcomings. The afternoon sessions featured a Keynote Address by award-winning Neurologist Dr Radcliffe Lisk, and Guest Speaker Yayah Conteh, the NGO and Donors Liaison Officer at the Ministry of Health and Sanitation (MoHS) – Sierra Leone. These addresses were complemented by case studies by Sierra Leone Diaspora-led organisations currently running projects across Sierra Leone, focusing on the successes and challenges faced.

A copy of the complete program is available at the end of this summary. Brief notes of the presentation are included in this Report; the full presentations are available at www.sliip.org (Reports).

Summary of Delegates

The Forum brought together health professionals from various disciplines within the S ierra Leone Diaspora. The delegate invitation was compiled by Michael Vincent of MV First Travel and SLDN. There were seventy-eight (78) pre-registrations, with sixty-eight (68) registered attendees. Of this latter group, twenty-nine (29) professionals completed a skills audit form. The information given on these forms served to highlight the keys areas of expertise which would benefit the development of the health sector in Sierra Leone as follows:

• Biochemist / Microbiologist
• Education and training
• Health Economist
• Health Information systems expert
• HIV / AIDS Project worker
• Infant and maternal health care
• Medical Doctors
• Mental health professionals
• Midwives
• Nurses
• OBGYNs (including at Registrar level)
• Pharmacist – Directorate level
• Project Strategists and policy developers
• Researcher / Auditor
• Sickle cell disease experts
• Vector Biologist
• Ward Managers

A full List of Delegates can be found in Appendix B

M orning Presentations: Health Priorities in Sierra Leone: The Statistics and the Threats

Opening

Victor Mengot opened the meeting by welcoming all participants and extended apologies from His Excellency Mr Melvin Chalobah and Mrs Dunni Chalobah who were unable to attend the meeting due to ill-health. The purpose of this session was to provide current statistics and information on the areas of priorities within the health sector in Sierra Leone, and to highlight what the Diaspora can do to effectively intervene.

Infant and M aternal Health Care / M ortality

Presentation by Dr. M atthew Clark – The Welbodi Partnership

Mission: The Welbodi Partnership works to support the M inistry of Health and Sanitation in Sierra Leone to deliver high quality paediatric care. Dr Clark gave a comprehensive presentation on Welbodi’s work in Sierra Leone, in particular their work at the Ola During Children’s Hospital. He provided statistics which highlighted the dire needs within paediatric care in Sierra Leone. The presentation set out Welbodi’s key principles as well as the three main problems affecting child morbidity and mortality. Finally, Dr Clark made recommendations for Diaspora intervention as follows:



Skilled personnel



Provisions of drugs and equipment



Training programmes



Improved management



Ideas and Innovation / Improvement in standards

HIV / AIDS in Sierra Leone

Presentation by Dr. Charles Senessie – The Afro-European M edical and Research Network (AEM RN)

In examining Sierra Leone’s fight against HIV/AIDS, Dr Senessie stressed the importance of effective networking and partnership. He provided a background to the current problems faced in Sub-Saharan Africa, showing the increasing number of people affected by the

• disease. , Dr Senessie also highlighted the critical shortage of health care workers caused by the

migration. The needs are many, but focus should remain on:



Getting credible statistics and data to do things better



Dealing with the stigma



Using local wisdom & local ways in SL context to address the issue



Overcoming the digital divide

The Threat of M alaria

Presentation by Dr Boi-Betty Udom – Roll Back M alaria

With 100% of the S ierra Leone population at risk from malaria, Dr Udom spoke about the startling mortality and morbidity rates in S ierra Leone. As well as setting out the aims and

• bjectives of Roll Back Malaria, she also highlighted the key areas of intervention including: disease

management; a multiple approach to prevention; a programme focusing on advocacy, information, education & communication, and research. There are two main priorities for 2009-2010, namely the development of a fully functional malaria programme as well as an effective health system.

Recommendations for Diaspora Intervention Diasporans can support existing programmes through the provision of:



Insecticide nets which can eradicate malaria - $7 to get a net (from procurement to beneficiary)



Indoor Residual Spray

M ental Healthcare in Sierra Leone

Presentation by Amadu Timbo & Emma Orefuwa - M ental Health CPR

Traditionally, this is an area of health care that no-one talks about, but mental health is a reality to over 50,000 people (reported cases) in Sierra Leone. In examining the current state

• f mental health, Amadu Timbo and Emma Orefuwa presented the vision and mission of the
• rganisation, which is to deliver mental health care, promotion and recovery services in
• rder to improve the quality of life for mentally ill people in Sierra Leone. With only one

psychiatric hospital and one qualified psychiatrist in the whole country, no training or community care, mentally ill patients face a bleak future without intervention. Diasporans can provide support by:

• Volunteering
• Fundraising
• Networking
• Campaigning
• Providing expert advice
• Brainstorming

Constraints to Primary Health Care Delivery

Presentation by Victor M engot

An expert on health care delivery in developing countries, Victor Mengot provided a list of current national health priorities, in relation to PHC delivery. Constraints to effective delivery include affordability, accessibility (due to poor roads infrastructure), poor water sanitation, poor maternal health care, lack of medicines, drugs and equipment and a desperate skills gap. Diaspora intervention can be focused

• n the following:



Assisting the development of outreach programmes



Staff training and mentoring



Project co-ordination



Identification of ‘Best Practices’



Fundraising



Advocacy

Water Sanitation

Presentation by Paul M assaquoi - Crystal Clear Klin Wata Foundation (CCKWF)

Good health in any country cannot be achieved without access to clean water and proper

• sanitation. Paul M assaquoi, founder of CCKWF provided valuable insight into the water and

sanitation problems in Sierra Leone, which include old and ineffective distribution systems, low water tariff and a poor billing system. M ost of the diseases that plague the nation are water borne diseases such as cholera, dysentery and malaria. Over 50% of the nation’s current water production is unaccounted for, as a result of leakages and illegal use. M r

M assaquoi concluded by recommending areas in which the Diaspora can intervene, the most pressing of which is the need for an effective advocacy programme on good sanitation.

Speakers

Guest Speaker: Yaya Conteh (M oHS Representative) - Donor NGO and Partners Liaison Officer

Mr Conteh provided a much needed Ministerial perspective to the delegates, setting out the current MoHS development plans being produced, which include a National Health Strategic Plan, as well as district and central plans. The reforms are planned with the aim of restructuring the health systems to reflect a new vision. There are major financial constraints, but in spite of this, the Government is working towards contributing at least 40% towards various programmes. Other constraints include the migration of skilled staff (especially after the civil war), no incentives either attract returnees or retain existing staff and inadequate conditions of service (low salaries and poor working environmental conditions, lack). The Government is working towards controlling this situation by setting up specific commissions, developing incentive schemes, and forming strategic partnerships to help with continuous education to improve personal skills. Based on the current needs, focus should remain

• n:
• Advocacy
• Resource mobilisation, provision and prioritization
• Health capacity building and Human resource for health
• Funding mechanisms to the health sector

Keynote Speaker: Dr Radcliffe Lisk –Consultant Neurologist

“The fact is that Fatmata started to die long before she got to the PCM hospital.” Award-winning Neurologist Dr Radcliffe Lisk gave an inspiring speech which highlighted briefly the state of the health sector in pre-war Sierra Leone, when Connaught Hospital could boast

• f

a neurologist, cardiologist, nephrologists and paediatricians inter alia. Sierra Leone now finds itself in the unenviable position of having to move backwards about 20 years to attain the position back then, in

• rder to progress and move forward.

M ost poignant was Dr Lisk’s recounting of Fatmata’s story and her demise at the hands of a catalogue of inadequacies, which included not only poor access to competent health care, but also the absence of clean water, and a poor education. So in truth, ‘Fatmata started to die long before she got to the PCH Hospital’. So layered are the problems that they have to be

dealt with by setting out priorities. Finally, Dr Lisk provided some recommendations for solutions to improving access to health care as well as for Diaspora intervention including:

• Raising funds for projects
• Exchanging skills on short and long term bases
• Holding consultations before making donations and make sure locals are trained to used any

equipment

• Arranging placements for home students
• Advising on policies
• Working towards transfer of technology – the most sustainable help we could give
• Training locals to acquire some competencies

Afternoon Presentations: Current Diaspora Projects – Successes and Challenges

The purpose of this session was to highlight the important contributions that Diaspora-led

• rganisations have made to Sierra Leone’s development over many years. Although most of these
• rganisations have adopted a multi-sectoral approach to development, the focus was on the health

sector, in keeping with the theme of the Forum. Presenters were also asked to provide a background to the challenges encountered. A common thread that ran across the various presentations was the importance of establishing structures of sustainability within the projects. These presentations were meant not only to inform delegates on the successes and challenges, but also to inspire other Diasporans were may wish to initiate similar projects in Sierra Leone.

The M asanga Hospital Rehabilitation

Presentation by Dr Edward Cole and Dr Peter Bo J

• rgensen

The rehabilitation of the M asanga Hospital in the Tonkolili district is supported by a tripartite agreement between the Sierra Leonean Adventists Abroad (SLAA), the Association

• f Friends of M asanga (AFOM ) and the Government of Sierra Leone. A BT Community

Award winner, a rehabilitated M asanga Hospital opened its out patients department in 2006 at what was originally the M asanga Leprosy Hospital. With the help of medical professionals, other health agencies and volunteers from Denmark, the Hospital has achieved some major milestones, including retaining 85 members of staff, treating approximately 2500 patients per year and improving access to health care to the wider community. Summary of current needs

• 1. Widening the medical capabilities of the Hospital (e.g. the maternity unity, accessing

more drugs and equipment)

• 2. Developing the hospital infrastructure (access to clean water, power and

rehabilitation of derelict buildings)

The Sierra Leone War Trust for Children (SLWT)

Presentation by Yvonne Aki- Sawyerr and Renée Horton-Spring

“In order to help a child you need to help the community

in which they belong”. Both Yvonne Aki-Sawyerr and Renée Horton-Spring provided the attendees with an insightful overview of their achievements over the past decade. Since 1999 to date, SLWT has run four holistic projects, three of which have included health interventions. These have included:

• A child immunization drive
• Training of health workers
• Provision of water wells
• Construction of ventilated improved pit (VIP) latrines, and
• The construction of a health clinic.

Challenges have included retaining staff in remote areas, cost of equipment, lack of electricity and establishing and maintaining effective communication with relevant government ministries.

HealthySalone

Presentation by Dr Aminata Kanu

Healthy Salone’s overall aim is to mobilize resources to improve health indicators by controlling and reducing the major diseases in Sierra Leone. Its current focus is on the Army Medical Service, which although not a part of

the MoHS, is a microcosm of the whole health system in Sierra Leone. Healthy Salone’s work stands on three main pillars of Innovation, Stocktaking & Accountability, and Sharing and

• Partnership. As the Projects and Programmes prepare to commence, Dr Kanu made a direct call

for support from the audience in order to improve the conditions at the military hospitals / delivery services across the country.

The Afro-European M edical and Research Network (AERM N)

Presentation by Dr Charles Senessie and M ark M acauley

AEM RN is a “non-Govermental and non-profit Organisation with a strong vision of helping to improve the quality of life for people from and living in resource limited settings.“ The organisation works in collaboration with various partners from South Africa, Kenya and Zambia. The main project in Sierra Leone is the High-Tech Energy Light Project (HELP), which seeks to reduce the amount of money poor households have to pay towards fuel for energy. Due to time constraints, M ark M acauley was unable to present full details on this Project. However Dr Senessie provided the delegates with a background to the various global projects and partnerships they have forged over the years. A major part

• f AEM RN’s success is its online Forum which provides and opportunity for members to

share ideas and experiences, as well as for the dissemination of pertinent information. AEM RN aims to build upon above collaboration for the intiation and promotion of Research in these resource constrained settings.

The Organisation

• f

Sierra Leone Healthcare Professionals Abroad, (TOSHPA)

Presentation by Elizabeth Conteh

TOSHPA is “network of healthcare professionals of SL origin who volunteer (in Sierra Leone) technical assistance and supervision in their area of expertise. The primary responsibility of the volunteer is to build local capacity through training of local healthcare professionals”. Medical professionals with a minimum of three years’ experience in their field of expertise are encouraged to volunteer for a period of four to six weeks. Working directly with health care workers, volunteers will act as mentors, exchanging knowledge and experiences. Mrs Conteh made a direct appeal to attendees to volunteer in Sierra Leone.

Discussion Sessions

It is impossible for this Report to fully capture the passion of the delegates during the discussion sessions. There was as much concern about the Government’s commitment to supporting Diaspora intervention in the health sector, as there was enthusiasm and a willingness to contribute to its development. The discussions were short and to the point. A few of the questions asked and points made, have been selected as follows:

• With the strategies listed/ new structures, do they still have the capacity to move

very fast? How to overcome some of the old barriers? Children need to be taught about hygiene and charged communities fees when they fail to follow the rules

• Orgs like SLDN to be on a board on Ministerial level – some individuals could have

their own agenda and could stifle development

• What is the state of primary health care in SL?
• There is a need for an immunisation campaign
• What are the strategies in place for primary prevention?
• What are the plans for Health education?
• How is the problem of counterfeit medication being tackled?
• How can the Government support Diasporans who ship goods over for charitable;

purposes but progress is stumped by requests for bribes, theft / disappearance of goods and inability to fully clear goods from the Ports; Recommendations made include:

• The lack of a mental health policy is a problem and primary mental health care

should be made a priority;

• The introduction of a National Insurance scheme;
• As donor funds decrease, Sierra Leoneans need to be more proactive towards self-

sufficiency (Ghana is an example);

• The MoHS needs to come with a ‘shopping’ list which the Diaspora and partners can

work towards;

• Paul Summerfield, Director for Development at the Royal Society of Medicine (RSM)
• ffered to host next year’s Health Forum at the RSM, and personally offered to cover

the costs for lunch.

Appeals from the Audience:

Sickle Cell Carers Awareness Network (SCCAN) by M rs Sia Nyandemo

Prior to the meeting, Iyamide Thomas, Regional Care Advisor of the Sickle Cell Society in the UK had expressed her concern that sickle cell disease had been omitted from the programme, in spite

• f it being the fourth cause of death amongst children in the developing world. Mrs Nyandemo

shared this concern with the audience, as she asked for support for SCCAN’s aim to offer a variety of services to meet carers', individual, family and community needs to enable and empower them to care more effectively. Current Need: an Electrophoresis machine to diagnosis the disease in Sierra Leone

The Verna Iscandari-J

• hnson Initiative (VIJ

I) – Female Oncology Ward by J acqueline J

• hn

Sierra Leone is not equipped to diagnose nor offer care for cancer sufferers in Sierra Leone. This eponymously named organisation was set up with the aim of supporting a Partnership between the Oncology department in Connaught Hospital and a Health Link for the relief of sickness of Patients treated for Cancer. Current need: After long negotiations, VIJI has officially secured the space for a female oncology ward at the Connaught Hospital. However funds are needed to fully equip and manage the ward.

The Way Forward

Diaspora Volunteering Package - M V First Travel Presentation by M ichael Vincent

Having consulted with many S ierra Leoneans over many years, MV First Travel has identified a gap in the provision of a comprehensive and reasonable holiday package, inclusive of travel and accommodation for Diasporans wishing to ‘give back’ to Sierra Leone by volunteering across various sectors during their holidays. All health professionals will have

• f their time to volunteer

Michael Vincent, a core member of the Health Forum Planning Committee, informed the audience of an innovative travel package which offers all health care volunteers a package holiday at a cost, thus facilitating a more productive and effective volunteering drive.

Framework for an active Health Working Group

Chaired by Victor M engot

Victor Mengot directed this plenary session as an opportunity to pull together all the facts presented and the recommendations made, in order to set out the key issues and an achievable list of action points, as follows:

• Representation in Sierra Leone: we can collaborate to pay the salary of an Officer in

Sierra Leon to push our agenda forward; a representative will be answerable to the Diaspora;

• Develop a 12-months plan: Creating a tick-list so we can assess progress : (comprising

Paul Summerfield’s suggestion of a ‘shopping list’);

• Strengthening Health Sector Support Group: a group like TOSHPA means we can have

direct representation in the Health Committee in SL. These meetings in Sierra Leone are held every three months and Diaspora representation is vital;

• M OU: Issues with transparency, accountability, no need for bribes / corruption etc

hinder progress. Roles and Responsibilities have to be drawn up with the MOHS. Diasporans were asked to make recommendations on the points to be included in this M OU. Also needed are people skilled in drafting policy documents such as these;

• Project Coordination: SLIIP is a central point where documents / projects can be
• showcased. A lot can be achieved with good coordination: if each of the NGOs in SL

adopts a clinic in SL, there will be progress.

• Setting targets: For example, ‘Reduce the rate of maternal mortality by 2011’, to

coincide with Sierra Leone’s 50

th anniversary of Independence

• Volunteering Package: Michael Vincent of MV First Travel has offered a comprehensive

package for travel: a highly competitive package

• Fundraising: Organisations may have funding, but need to endure sustainability. We

need to be self-funding! A final call was made to all delegates to send in suggestions for the MOU between the Diaspora and the MoHS. Delegates were thanked for their attendance, and encouraged to make use of the remaining time by networking.

Appendix

APPENDIX A: Programme

10:30 Registration / Beverages 11:30 – 11:45 Welcome – Victor Mengot (Meeting Chairperson) Introductions 11:45 – 13:00 Health Priorities in Sierra Leone: The Statistics and the Threats 11:45 – 12:35 Presentations



Water Sanitation: Klin Wata (Paul Massaquoi)



Infant and M aternal Health Care / M ortality: The Welbodi Partnership (Matthew Clark)



HIV / AIDS: The Afro-European Medical Research Network – AEMRN (Dr. Charles Senessie)



The Threat of M alaria: Roll Back Malaria (Dr Boi-Betty Udom)



M ental Health in SL: Mental Health CPR (Amadu Timbo)



Constraints to Primary health care delivery: Victor Mengot 12:35 – 13:00 Discussion 13:00 – 13:30 Break 13:30 – 14:30 Speakers 13:30 – 13:45 Keynote Address



Dr Radcliffe Lisk – Health sector priorities and Diaspora Intervention 13:45 – 14:00 Guest Speaker



M r Yayah Conteh (NGO Liaison Officer – M inistry of Health and Sanitation, Sierra Leone) – The Role of the Ministry in Diaspora Intervention 14:00 – 14:30 Discussion 14:30 – 15:25 Current Diaspora Projects: Successes and Challenges 14:30 – 15:05



The M asanga Hospital Project (Dr Edward Cole and Dr Peter Bo Jorgensen)



The Sierra Leone War Trust – Health Projects (Yvonne Aki-Sawyerr and Renee Horton- Spring)



The Afro-European M edical Research Network - AEM RN (Dr Charles Senessie)



Healthy Salone (Dr Aminata Kanu)



The Organisation of Sierra Leoneans Health Professionals Abroad - TOSHPA (Elizabeth Conteh) 15:05 – 15:25 Discussion 15:25 - 16:15 The Way Forward Skills Audit Forms

 Presentation of the Diaspora Volunteering package: SLDN, Ministry of Health – SL, MV First

Travel

 Framework for an active Health working group (Strategy for meeting the health-related

M illennium Development Goals target (i.e. reduction in maternal and child mortality rates and reduction in preventable and communicable diseases)

 Final Discussions

16:15 – 16:45 Vote of Thanks / Networking

APPENDIX B: Delegates List

Abigail Taylor Adeyemi J

• hnson

Alie Toronka Amadu Timbo Anifa Cole Davina Springer Derek Bangura Donald Conteh Dr Aminata Kanu Dr Andrew Curtis Dr Boi-Betty Udom Dr Charles Senessie Dr Edward Cole Dr Glennis Williams Dr Iris Rogers Dr J

• seph Edem-Hotah

Dr J

• seph Will

Dr J

• yce Elliot

Dr M onty Harding Dr Peter Bo J

• rgensen

Dr Radcliffe Lisk Dr Radcliffe Lisk J nr Dr Sarah Francis, Dr Tom Lissauer

• Dr. M atthew Clark

Edward Vandi Elizabeth Conteh

Emma Orefewa Fayie Iscandari Felitta Burney-Nicol Hawa Sesay Ibilola Campbell Ibrahim Kanu Iyamide Thomas J acqueline J

• hn

J ames Allie J

• hn Gordon

Khadiru M ahdi Lawrence Teh M ahene Williams M annah Kargbo M ariama Tejan-J alloh M arion M organ M ark M acauley M ary Olusile M elvin Wilkinson M ichael Vincent M ildred J

• hnson

M o Osman-Kamara M ohamed Bangura M ohamed J amie Komeh Nyamacoro Sarata Silla Paul M assaquoi Paul Summerfield Renee Horton-Spring

Ronita Shaw Sahr O. Fasuluku Seton During Sia E Nyandemo Victor Cole Yayah Conteh Yvette Gordon Yvonne Aki-Sawyerr Yvonne Crowther-Nicol SLDN Ade Daramy Berni Sam-King Georgina Awoonor-Gordon M argarette Stevens Victor M engot