Give an overview of the main barriers to access to medicines in Sierra Leone.

Give an overview of the main barriers to access to medicines in Sierra Leone. Taking the example of one or two barriers, critically appraise one intervention being used to overcome this barrier/these barriers.

Overview

Most countries want to move towards universal health coverage – people being able to access quality essential health care without financial barriers or adverse consequences. If you can’t provide the full range of services to all – which is the case for all low income countries – then one approach is to offer free care for high priority users. This is what was done in Sierra Leone in 2010, when the Free Health Care Initiative (FHCI) was launched, offering free care in public facilities for pregnant and lactating women and under-fives, in a context of one of the highest maternal mortality ratios in the world. Six years on, we report on how that policy was implemented, what it achieved, and what we can learn from it.

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The FHCI in Sierra Leone stood out for taking a broad approach. Although the focus was on making mother and child health services free,  the Government and its partners realised that in a weak, post-conflict health system this could only be done if all of the main health system elements were improved: availability of staff, structures for managing the sector, monitoring and evaluation, drugs and supplies, health facilities, and communication, all of these needed to work better if free care was to be meaningful. For fee removal, this is lesson number one: take a systemic approach….