The Sierra Leone I Want to See: Individual, Community and National Responses for a Better Healthcare System in a Post-COVID-19 Sierra Leone

Moments of crisis offer unique opportunities for behavioral change, institutional reform, community repositioning and policy rectification. Periods like war and health crises shape or reshape the way things are run. And the COVID-19 pandemic is no exception in this regard.

In Sierra Leone, however, it appeared as though the Ebola virus outbreak was not a calamity, harrowing enough for individuals, communities and the government of Sierra Leone to draw lessons from. This was apparent in sluggish attempts towards improving healthcare in post-Ebola in the country.

It could be presupposed from the multifaceted effects of COVID-19 on the country that Sierra Leone’s healthcare system direly needs reforms. Lessons can as well be learnt from the inadequacies in health equipment to cushion the effects of COVID-19 that Sierra Leone must seek to earnestly incorporate innovation and technology in its educational system.

Strengthening national responses for a sustainable and better healthcare system in a post COVID-19 Sierra Leone, among other things, means addressing those long-standing healthcare and healthcare-related weaknesses exposed by both Ebola and COVID-19 outbreaks.

These include but not limited to establishing a permanent national center for disease control, expanding our medical school and funding health research, building hospitals in all towns and health peripherals in major villages, establishing pharmaceutical companies, constructing isolation centers in all towns, producing home-grown medical and personal protective equipment (PPEs) and incorporating innovation and technology in our educational system.

To start with, to achieve a national response for a better healthcare system in a post-COVID-19 Sierra Leone, the government should establish a permanent national health response center. A center that is well-equipped with modern laboratories and other facilities that will enable it reach international standard.

Establishing a permanent national response center or a center for disease control would not only prepare the country in the event of a disease outbreak but also ensure a national preparedness and response that is operational and well-coordinated to manage health emergencies.

A national response center that is in operation before an outbreak can be better capacitated to prevent outbreaks or to control communicable diseases from spreading rapidly.
According to World Health Organization (WHO), countries with national-health-response centers prior to outbreaks have the likelihood of preventing diseases from spreading and/or containing them from becoming deadly.

The national response center will be responsible to prevent and control infectious diseases and to provide consultations and assistance to the Ministry of Health and Sanitation in improving community health and health promotion activities in the country.

This center will conduct research on disease transmission and prevention. This will help promote Sierra Leone’s healthcare system.
Having a permanent national response center prevents the creation of ad hoc national emergency response centers that are poorly coordinated to manage health crises and that easily collapse when the risk of health emergencies is minimized.

Arguably, Sierra Leone would have been a more prepared nation to fight against COVID-19 if the Ebola emergency infrastructure were still in place. Thus, having a permanent national response center plays a meaningful role in preparing Sierra Leone’s national response for a better healthcare system.

Similarly, in post-COVID-19 Sierra Leone, the expansion of the country’s medical school should be prioritized in order to get a better healthcare system. There is no gainsaying that the country has only one medical school, which has been in operation for over thirty years. Establishing other medical schools in the country and/or upgrading College of Medicine and Allied Health Sciences (COMAHS) with modern laboratories, with a medical library and a bio-medical research lab are brilliant steps that should be taken to get a sustainable better healthcare system.

The medical school or schools should be upgraded to offer postgraduate courses in medicine and in medicine-related programs. This assures the country the provision of adequately trained and qualified medical practitioners and highly professional medical specialists the country can retain in her efforts to strengthen her national response for an improved healthcare system.

In the same vain, just as other international medical universities do, like the University of Michigan and the University of Ghana, our medical school should be adequately funded to conduct research on bio-medics, on epidemiology, on viruses and on disease formation, transmission, prevention and control.

The government should invest largely in medical research. These will help provide home-grown solutions to tackling diseases through the production of vaccines and antibodies in the country. “These will bridge the gap between bio-medics and traditional medicine in the country,” as mentioned by Dr. Alhaji Njai. It will also help de-emphasize our heavy reliance on foreign aid, particularly in periods of health crises.

To solidify our national response for a better healthcare system in a post COVID-19 Sierra Leone, the construction of modern hospitals and renovation of already existing ones in all districts and the building of health peripherals in all major villages should be given a close attention.

The hospitals and health clinics should be well-equipped with modern hospital beds and with personal protective equipment. Hospitals and health peripherals should have uninterrupted supply of medical equipment, drugs and medicine, medical personnel, logistics, electricity and clean water.

The hospital systems should be digitized and data stored accordingly and electronically. Hospitals should be made habitable and relatively safe for medical patients. Medical doctors should be approachable and nurses and health workers should be welcoming and easy-going. Government hospital boards should formulate policies that make public hospitals consumer-friendly, just as private hospitals or clinics do.

By the same token, readily-working ambulances should be stationed in peripherals and in all far-reaching villages to transport patients with intensive medical needs to hospitals safely. These will reduce the high number of people who die of curable illnesses every year and will prevent maternal and infant mortality in the country.

There should be a well-structured communication system in place between and/or among peripherals and hospitals. With these in place, a resilient national response for a sustainable medical care is easily achievable, as health coordination will be intact.

Going further, in post COVID-19, Sierra Leone wants to see a healthcare system where salaries and conditions of service of medical practitioners, particularly in times of health crises, are of utmost priority to the government. To get a strong national response for a better healthcare system in a post-Sierra Leone, the government must be ready to pay medical workers and improve their conditions of service. The salaries of medical practitioners must not be delayed for any reason. “To retain our medical doctors in the country, their jobs should be made lucrative and enviable just as it happens in other countries,” as stated by Dr. Baldeh of Junior Doctors Association of Sierra Leone.

This will prevent brain-drain, which the country’s medical sector has always suffered from. And during health crises, medical doctors, nurses and other front liners should be well-compensated, given appreciable allowances and appreciated.

More importantly, there should be a legislation that protects the welfare of medical practitioners in times of health crises. Those who lose their lives on duties in periods of health emergencies should be celebrated, and their families taken care of by the government.

Additionally, to reduce Sierra Leone’s heavy reliance on foreign countries for drug supply, especially in moments of health crises, the government should establish pharmaceutical companies that manufacture home-grown drugs. The establishment of pharmaceutical companies should be in line with international practice of drug production. University departments of science, chemistry and physics should be strengthened in order to turn out well-trained and highly qualified chemists, scientists and physicists that would enable the country manufacture drugs and antibodies.

The pharmaceutical company should make use of traditional medicines for better medicine production. This will ensure a continuous supply of medical drugs in the country and will reduce the large scale importation of drugs into the country.

Also, the country should construct permanent isolation centers and quarantine facilities that are habitable across the country. These facilities will exclusively be used for housing people with signs and symptoms of communicable diseases.

This will prevent frantic construction of temporary isolation centers or the turning of public hotels and institutions into quarantine centers during disease outbreaks. It is not always the case that government has to wait for diseases to break before they start to identify public places as quarantine facilities. What if COVID-19 overburdened hospitals as it did in Italy and in other places? What could have been the state of our current medical system? It is therefore recommended to construct permanent quarantine centers at all national borders and crossing points and in all districts across the country.

The incorporation of innovation and technology in our educational system is another aspect that direly needs reforms in a post-COVID-19 Sierra Leone. The COVID-19 pandemic has exposed Sierra Leone’s failed attempts towards transforming its education from that of bookish to that of innovation, invention and technology.

In highly acclaimed public higher learning institutions in Sierra Leone, more of art courses which do not meet modern developmental trends are offered. Courses that shift students’ attention to innovation and technology are sorely lacking in our academic system. And the engineering courses have not done well so far in creativity and innovation in the country.

However, at the time when COVID-19 peaked, Njala University produced a ventilator machine to help patients with respiratory difficulties and College of Medicine and Allied Health Sciences also produced customized hand sanitizers. These are indicators that if large scale investment is made in innovation and technology in the country, Sierra Leone will be capacitated to invent and develop customized equipment, like drones, that will strengthen our national response for a better healthcare system, as other countries have done.

This speaks to the fact of why innovation and technology should be incorporated in our educational system. The educational system should work towards moving from analogue to digital. With a digitized educational system, students and educators will remain safe and hold lectures during health crises while the country fight against diseases.

It is also worth mentioning that to get a national response for a better healthcare system, the government, public hospitals and health emergency workers should operate in a way that the public cultivate trust in their operations. As we see in other countries, people run to public hospitals and health emergency centers when they feel that they have signs and symptoms of communicable diseases. This is because they believe in their healthcare systems and health workers. In Sierra Leone, however, the opposite happens. People carrying signs and symptoms of infectious diseases mostly do not willingly report themselves to health emergency centers. They rather do self-medication or run to traditional doctors. This is because Sierra Leoneans do not trust governments and health emergency workers, and they believe they will be killed should they report themselves to medical centers during health crises. This led many to believe that Ebola was not real. This has also been the case of COVID-19. Majority of Sierra Leoneans do not, even after COVID-19 has claimed the lives of many people, believe that the COVID-19 that devastated Italy exists in the country. Many hold the view that the government claimed COVD-19 in order to siphon foreign health aids and donors just as it happened during the Ebola epidemic.

Going further, therefore, governments, as they conduct sensitization programs on disease control and prevention, must understand priorities and must do that which can make people place trust in their operations, especially that which has to do with health.

Sierra Leone also needs more health data system to improve response for a better healthcare system. Sierra Leone needs to strengthen its data and statistical capacity, especially in civil registration, to be able to respond to coronavirus and future health challenges accordingly. Data coverage on health facilities and health outcomes in Sierra Leone is often poor, and this limits the production of data essential in health emergency response.

The lack of statistical capacity is an obstacle to obtaining health data in Sierra Leone. Sierra Leone Statistics and the Directorate of Science, Technology and Innovation should create an information system that stores data that can be used for contact tracing and for medical research.

Beside government’s roles in getting a national response for a better healthcare system in post OVID-19 Sierra Leone, communities and individuals should also take ownership of health facilities provided in their communities. They should protect health facilities and promote better healthcare in their environments.

Residents of various communities should clean their environments and work with medical doctors and health agencies to promote environmental sanitation. Individuals should report themselves to hospitals when they feel unwell, and they should as well report sick people who are unwilling to go to hospitals for medical checkups.

Individuals must learn to take health precautionary measures seriously without being coerced by security officials. There should be community by-laws that protect and promote community healthy living. Individuals and communities should set up health promotion advocacy groups that complement the efforts of government and health workers.

These health advocacy groups should mobilize community support to help government fight against diseases during health emergencies.

In conclusion therefore, it takes government’s readiness, medical practitioners’ willingness, community preparedness and real behavioral change to get a sustainable and better healthcare system in a post COVID-19 Sierra Leone.

It can be done, and when it is done, then we will all enjoy the healthcare we have long wished for.