FREETOWN, Sierra Leone — Up until two years ago, the maternal death rate in Sierra Leone was the highest in the world with 1 in 8 women dying during pregnancy or giving birth. That is when the Ministry of Health and Sanitation introduced free health care for lactating and pregnant women and children under the age of five. Despite successes, women are still having trouble accessing care in Sierra Leone.
Nurses tend to patients in the general hospital in the town of Makeni, in the northern part of Sierra Leone. The government began offering free healthcare to women and children at all government run health facilities two years ago. Since then, women from rural areas have flocked to health centers to take advantage of the services.
Money to run the program so far has cost about $40 million, with most of it coming from donors such as the United Nations Children’s Fund, UNICEF. And the U.N. notes the program has produced success in a short time - such as cutting mortality rates in children and women by half.
The free health care program is supposed to cover all health-related expenses for pregnant women, lactating mothers and children under five years of age. This includes all medication, services such as referrals, consultations and formal visits, surgery, and ambulance service.
But Amnesty International's 2012 report on Sierra Leone and the free health initiative, says many women continue to pay for essential drugs, despite the free care policy.
Adama Koroma is one of them. She says a nurse asked her to pay for her baby daughter's medication at the hospital in Makeni.
"They told me that they don't have those drugs, to buy those drugs on my own," said Koroma. "But I didn't have money, so I had to come home and sell some of my things."
And women in rural areas face even more challenges accessing the health system. Koroma says poor roads make it hard for many women she knows to get from their villages to the Makeni hospital or a health center.
When she was in labor, Koroma tried to make the six-mile trek to the nearest health center. She wound up delivering her baby in the bush with the help of her aunt despite the fact that the program should have offered an ambulance service.
"The road was so bad I could not reach a motor vehicle to help me reach on time," she said.
Fatmata Kanneh, head of the maternity unit at the Makeni hospital, says there have been some noticeable improvements since the free health care program was introduced such as a reliable supply of certain medications.
"We always have emergency drugs, especially in [the] maternity unit, even children under five are getting their treatment," said Kanneh. "We have blood in [the] blood bank for emergencies."
There are different problems for women in the cities. In the capital, Freetown, patients note that free health care does not mean available healthcare.
Here at the Princess Christian Maternity Hospital, or PCMH, Hawa Lanai says she and her one-year-old son Mohamed have been turned away four times from the hospital because there hasn't been a doctor to see them.
"The patients are so many," said Lanai. "He can't see to all of them at times - even now when I'm coming he is not even in."
Sierra Leone's Minister of Health and Sanitation, Zainab Hawa Bangura, says the government is looking for solutions to some of these problems, caused mainly by a huge increase in demand for service. She notes that before the free program was introduced, staff at the PCMH saw about 800 women a year. Since then, the number has risen to about 12,000 women.
"The challenge we also have is human resource, it takes seven years to train a doctor, it takes time to produce professional staff," said Bangura.
Amnesty International notes other issues - such as lack of monitoring, misuse of medication and no avenue to report problems in the system.
Bangura says the government is also working to address these issues. She says a new system will soon be put into place where women in rural areas will serve as watchdogs over health centers in their community. Each woman will be given a cell phone which connects them to a main call center in Freetown to report violations.
"So her job every day, is to visit facility and if staff not there, drugs not there, she will file a complaint and we'll take action against staff," she said.
Meanwhile, women who should be able to access free care at government health centers are instead heading to the Greatest Goal health clinic run by an American non-governmental organization. Its lab and care facilities are better stocked and staffed.