By: Habib Abdur-Rahman
Freetown — Ten years since the end of Sierra Leone’s civil war (1991-2002), the country’s image is being transformed both at home and abroad. No longer the site of brutal exploitative conflict, it is now one of the fastest growing economies in the world and a nation recognised by the UN as an “evolving model country for overcoming old divisions and [one] developing into a peaceful, democratic, and prosperous country”.
Nevertheless, below the surface of this rapid growth, Sierra Leone continues to be fraught with numerous serious and pressing social problems, not least in terms of health. As well as the direct impact on the population, healthcare could have long-term effects on the country’s economic development and, in the short-term political environment, be an important issue when Sierra Leone goes to the ballot box this November.
Progress with problems
President Ernest Bai Koroma has made significant progress in a country that boasts an unfortunate history of 17 years of one-party rule, 13 military coups and 11 years of civil war. Some recent achievements of his government include the Bumbuna hydroelectric dam, new roads between major towns, large-scale mining projects, a new railway line, and smallholder commercialisation programmes in agriculture.
But these developments have not always been seamlessly successful. The Bumbuna dam, for example, provides 50 megawatts of electricity at full capacity, only half of which the country’s national grid can cope with in its current state. Similarly, much of the country’s copious arable and fertile land and water remain unused and neglected.
Furthermore, Sierra Leone’s iron ore mining projects, while fattening the public purse, do not appear to be delivering the level of benefits originally envisaged. And road networks, despite improvements, are still highly inadequate, effectively cutting off hundreds of thousands of rural Sierra Leoneans from the country’s major markets, and more importantly, its health facilities.
Sierra Leone’s economy appears to be steaming ahead at full speed, with the country forecast to be the fastest growing in the world this year. But this rise is being driven by the inflation of one dominant industry while everyday economic realities remain less optimistic.
Despite many years of mineral extraction, many people still find themselves living in conditions similar to those seen before the resource boom, and children continue to die of malnourishment and treatable diseases.
The civil war caused huge disruptions and, a decade on, large swathes of the population still lack access to the most basic healthcare. Consequently, life expectancy in Sierra Leone is half that of the developed world and, at 192 deaths per 1,000 live births, the number of infants dying before their first birthday is the worst in the world.
To tackle the country’s poor health indicators, the government prioritised healthcare by introducing a free healthcare initiative in April 2010. Funded by a variety of international donors, the programme provides free care for children under the age of five, pregnant women and nursing mothers.
Two years on and the results suggests services for mothers and children have increased significantly. The Lancet reported last year that the number of children treated for malaria, for instance, approximately tripled from the previous year.
However, essential medical supplies are not always available at health facilities and, when they are, women are often charged for medicine and care that should be provided for free. Staff shortages have meant that many women are simply out of reach, and there is a significant lack of specialised staff to deal with the more difficult cases.
Drugs are also being illegally re-routed for profit, raising fundamental questions about the country’s drugs procurement and management system. The government has begun addressing this issue, but until “leaks” (as they have been termed) are stopped, pregnant women and children are the ones paying the price.
Maintaining free healthcare is of course highly costly. Talk in parliament about a decrease in the proportion of government spending on healthcare, considered a step backwards by many, has raised concern both inside and outside the country. Some have argued that investment in other sectors, such as roads, energy and education, will serve to improve health indicators on the whole, while others contend that these would hardly make up for the lack of trained personnel and inadequate drug supplies.
The truth, however, is that a population’s health is not only affected by economic development more broadly, but that the nation’s collective health status affects the nation’s economic prospects. In the long run, investments in human capital like health or education theoretically raise incomes and, in turn, contribute to economic growth.
Development, however, takes time, particularly when leaders are simultaneously tackling corruption and trying to live up to the demands of the international community. Building the capacity to bridge the implementation gap – that is, the ability to translate policy into real change on the ground – in post-conflict countries like Sierra Leone, will take several years, if not decades.
President Koroma and the three governments since the end of the war have made headway in uniting a divided country and transforming it economically. But the need to strengthen national institutions in education, social services and, in particular, health, is more pressing than ever.
Habib Abdur-Rahman is an agricbusiness entrepreneur in West Africa. His specific interests span agribusiness, biotechnology and sustainable economic development in emerging and frontier markets.He was formerly a strategy consultant with Deloitte in London. He read Oriental Studies at the University of Oxford and holds a degree in Mathematics from Imperial College London.