Welfare and Poverty Effects of the COVID-19 Pandemic has said that Sierra Leone’s health and education sectors remain fragile even though disruptions to health and education services have been modest during the COVID-19 pandemic.

The pandemic led to schools being closed and health services being cut back. However, once the spread of the virus appeared to be under control, schools were re-opened. Also, the fear of backsliding in terms of teenage pregnancy and early marriage did not materialize.

“Yet, even though the worst fortunately did not occur, children in Sierra Leone did lose several months from their education and most likely missed key vaccinations. In a country with high child and maternal mortality rates, even relatively small lapses can have serious consequences” the report says.

The Bank says, although the COVID-19 pandemic has dramatically interrupted health care services in some cases, these interruptions overall have been scattered and limited, and the reduction in services during the worst months only 10 to 15 percent.

Disruptions to the use of key preventative health services (antenatal care (ANC) and vaccinations for children under 18 months) have been modest and were mainly limited to the early months of the pandemic.

Data from the first two rounds of the World Bank COVID-19 Impact Monitoring Survey (CIMS) finds that 11 percent of pregnant women skipped scheduled ANC visits in July 2020, but this number decreased to 4 percent by November/December 2020.

Unfortunately, the Bank says they do not have no pre-COVID-19 baseline for these numbers, but this provides an upper bound on the disruptions due to COVID as attendance was likely less than 100 percent before COVID. For childhood vaccination appointments, the numbers are 12 percent in July 2020 and 1 percent in November/December 2020.

Data from the CIMS (asking about place of delivery for any birth in the year previous) finds essentially no change in the place of delivery due to the pandemic. These results are mostly confirmed by analysis of facility-level data.

Data from the district health management information system has been analyzed by the Global Financing Facility of the World Bank. This analysis on the provision of different preventative health care services over the period March to July 2020 found reductions in antenatal care of 13 to 7 percent and in vaccinations of 18 to 5 percent, with the worst disruptions in March to May 2020.

Analysis of facility level data on delivery services did find a reduction of 11 to 5 percent for the period March to May 2020, which does not come out in the data from the CIMS.

Regarding education, the report notes that, although almost all students have returned to school, about a quarter of students are repeating a grade and rates are higher in rural areas and for poorer households.

Overall, 28 percent of students are repeating a class for the 2020-2021 school year (excluding students in JSS3 and SSS3 who were still waiting for exam results at the time the data was collected).

This seems to be higher than usual, the 2018 SLIHS found that only 8 percent of students (again excluding JSS3 and SSS3) repeated a class for the 2017-2018 school year. There is no significant difference in promotion rates by gender, but rates are higher for students in urban areas (particularly Freetown) and for wealthier students, although these differences are not large; the promotion rate is 72 percent for students in the poorest quintile and 75 percent for students in the richest quintile.

This is concerning a context where students are usually significantly behind in terms of class for age (about half of students of JSS age, 12 to 14, are still in primary school) and learning outcomes are poor (the human capital index finds that harmonized test scores for Sierra Leone are among the lowest in the world).