July 10, 2014


Hundreds of health workers unpaid for two years



Hundreds of health workers all across the country have gone unpaid for the last two years as a result of a deliberate policy of the Ministry of Health and Sanitation and the Government of Sierra Leone. These health workers are known as Maternal and Child Health (MCH) Aides and are of lower rank than the State Enrolled Community Health Nurses (SECHN), but nationally they form the front line troops in the battle against disease. All across the country, in villages and towns these MCH Aides are to be found in Community Health Posts (CHPs), Community Health Centers (CHCs) and Maternal and Child Health Posts (MCHPs), small medical outposts that are the first line of defense in the country’s fight against sickness. The MCH Aides, in their distinctive pink uniforms, are reputed to be better known and trusted in communities throughout Sierra Leone than their more senior colleagues, the SECHNs and SRNs. In theory, as the name implies, the MCH Aides’ main focus is on childbirth and the ante-natal and post-natal periods. In practice, communities all across Sierra Leone rely on them to treat all manner of ailments, although they have clear instructions to refer cases above their competence to higher level institutions. Their training is shorter (two years) than the SECHNs, and entry requirements are lower, but they are given instruction in general medicine.


With donor support, Sierra Leone has ramped up its training of MCH Aides in recent years. This has been one of the strategies to combat Sierra Leone’s very low ranking in the WHO Maternal Mortality and Infant Mortality Indices (read Sierra Leone Last in Maternal Mortality). In Freetown, at the District Medical Office at Cline Town, the biennual intake is approximately 100 students. Other districts across the country have similar programs. The class of 2010 graduated in 2012 and to date these MCH Aides are yet to receive their first salary, even though they have been posted to health institutions across the country. When natinpasadvantage visited the Ministry of Health recently, before the Ebola outbreak, and inquired into this problem ( read Interview with Sierra Leone’s Chief Medical Officer), we found an attitude of indifference. The Chief Medical Officer revealed that this was a systemic problem (and, by implication, policy) stretching back decades. Now these MCH Aides have suddenly become doubly, triply important as the first point of contact with the dreaded Ebola. From the point of view of the indifferent that we found at the Ministry of Health, a single mother in labour has implications for only two lives, but one Ebola case wrongly handled could potentially have disastrous implications for hundreds. Sadly, several MCH Aides are reported to have already lost their lives after contracting the disease.


Meanwhile, the government reportedly will be introducing an emergency budget in Parliament today (July 10, 2014) making provision for Ebola-related expenditures. The popular FM98.1 morning show today reported a case of a confirmed Ebola patient who left his home area in the East of the country and sought treatment at a government hospital in Freetown, where he was admitted for several days before his condition was diagnosed. This is the second such incident reported in recent days.