!

ub||c near|ng on the

Iree nea|thcare In|t|at|ve
8o, 18Lh Aprll, 2012

Save Lhe Chlldren and PealLh AlerL Slerra Leone
A8S1kAC1
An opporLunlLy for Lhe communlLy Lo LogeLher wlLh declslon makers and share
Lhelr experlence of Lhe lree PealLhcare lnlLlaLlve aL grassrooLs levels.

Iac|||tated by Save the Ch||dren and nea|th A|ert S|erra Leone
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Lxecut|ve Summary

8ackground:

ln llghL of Lhe 2
nd
Annlversary of Lhe lree PealLhcare, Save Lhe Chlldren and PealLh AlerL faclllLaLed a one
day ubllc Pearlng on Lhe lree PealLhcare ln 8o on Lhe 18
Lh
of Aprll. 1he ubllc Pearlng was well aLLended
by ulsLrlcL Medlcal Cfflcers, ulsLrlcL Councll Chalrpersons, Mayors, offlclals from Lhe MlnlsLry of PealLh and
SanlLaLlon, and, mosL lmporLanLly, Lhe publlc. A delegaLlon of communlLy represenLaLlves were ldenLlfled
from each of Lhe 14 ulsLrlcLs, and glven Llme Lo consulL wlLh Lhe wlder communlLy Lo gaLher feedback on
Lhe grassrooLs experlence of Lhe lPCl. 1he purpose of Lhe ubllc Pearlng was Lo glve communlLy members
Lhe opporLunlLy Lo engage dlrecLly wlLh key declslon makers on Lhe provlslon of Lhe lPCl, and Lo provlde
feedback and lnslghLs on Lhe successes and challenges of Lhls lnlLlaLlve aL ulsLrlcL and communlLy level.

1he ubllc Pearlng was exLremely successful, hlghllghLlng a number of challenges and lssues LhaL need Lo
be resolved boLh aL naLlonal and ulsLrlcL level. 1he response from Lhe publlc Lo Lhe lPCl was
overwhelmlngly poslLlve, however, lL was evldenL LhaL slgnlflcanL lmprovemenL ls sLlll needed Lo ensure
LhaL quallLy servlces are accesslble for Lhe lnLended beneflclarles. 1he ubllc Pearlng was noL a one off
evenL buL Lhe sLarLlng polnL for communlLles Lo engage declslon makers on Lhe healLh lssues affecLlng
Lhem. CommunlLy members who aLLended Lhe ubllc Pearlng wlll be meeLlng wlLh Lhe relevanL declslon
makers ln Lhelr ulsLrlcLs Lo follow up on Lhe dlscusslons and ensure speedy resoluLlon of Lhe challenges
ldenLlfled. PealLh AlerL and Save Lhe Chlldren wlll be dolng Lhe same wlLh Lhe MlnlsLry of PealLh and
SanlLaLlon, Lo ensure LhaL Lhey are fully aware of Lhe lssues ralsed aL Lhe ubllc Pearlng.

WhaL follows ls an overvlew of Lhe key acLlons LhaL Lhe publlc ls demandlng of Lhe MlnlsLry of PealLh and
SanlLaLlon, and ulsLrlcL Counclls. WlLhln Lhe reporL lLself are more deLalled recommendaLlons for each
ulsLrlcL, requlrlng lmmedlaLe acLlon by Lhe Councll Chalrpersons, Mayors and ulsLrlcL Medlcal Cfflcers.
Whlle many of Lhe lssues ldenLlfled are noL new, Lhese are Lhe lssues LhaL have been ralsed up Lo declslon
makers by Lhe publlc, Lhese are Lhlngs LhaL maLLer Lo Lhem, and musL be glven Lhe uLmosL aLLenLlon by
Lhose who have Lhe power Lo affecL change.


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key Act|ons kequ|red at D|str|ct and Nat|ona| Leve|:

1. I|nanc|ng 8|ood Donors - ulsLrlcL Counclls should be encouraged Lo make provlslon for flnanclal
lncenLlves for blood donors ln Lhelr yearly budgeLs - lL seems LhaL some are dolng Lhls buL noL all.

2. Ambu|ances - ulsLrlcL Counclls should be encouraged Lo ensure adequaLe funds are avallable for
fuelllng of ambulances, and LhaL fuel dlsLrlbuLlon ls on Llme.

3. Improv|ng keferra|s - ulsLrlcL Counclls musL ensure LhaL every Pu has access Lo Lhe phone
numbers of Lhe ambulance drlvers ln Lhe ulsLrlcL so as Lo enable a smooLher referral process.

4. Staff|ng - 1he MoPS need Lo puL ln place a sLraLegy Lo engage healLhworkers of all cadres on
lmprovemenL of aLLlLude Lowards paLlenLs. 1hls was Lhe number one lssue ldenLlfled by Lhe
communlLy members. 1hls should be a key facLor ln Lhe P8P SLraLegy currenLly belng developed.

3. Account|ng for Ne|ghbour|ng Countr|es - 1he MoPS needs Lo conLlnue Lo address Lhe lssue of
people from nelghbourlng counLrles accesslng Lhe lPCl, ensurlng LhaL Lhe quanLlLy of drugs
provlded Lo border ulsLrlcLs ls reflecLlve of Lhe lncreased upLake.

6. Staff uarters - 1he MoPS needs Lo conLlnue Lo lmprove/esLabllsh accommodaLlon for
healLhworkers, parLlcularly Lhose ln remoLe locaLlons. lL ls also necessary Lo ensure adequaLe
securlLy for healLhworkers.

7. Strengthen|ng Sens|t|sat|on - 8oLh ulsLrlcL Counclls and Lhe MoPS need Lo sLrengLhen senslLlsaLlon
around Lhe lPCl, parLlcularly ln rural and remoLe areas.

8. 18As - 1he MoPS needs Lo ouLllne a clear poslLlon on 1radlLlonal 8lrLh ALLendanLs and how Lhey are
Lo be uLlllzed, lncenLlves musL be parL of Lhls and should noL be lefL Lo Lhe dlscreLlon of Lhe Pu ln
Lhelr use of Lhe erformance 8ased llnanclng (8l).

9. Vo|unteers - 1he MoPS needs Lo address Lhe lssue of Lhe number of volunLeers LhaL are currenLly
susLalnlng healLh servlce dellvery across Lhe counLry. 1hose volunLeers LhaL are compeLenL musL be
absorbed lnLo Lhe sysLem so LhaL Lhey can conLrlbuLe more effecLlvely Lo servlce dellvery. 1he lssue
of volunLeers should be address ln Lhe P8P SLraLegy currenLly under developmenL.


u[ehun Commun|ty
kepresentat|ve
ub||c near|ng part|c|pants
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Cpen|ng Address from nea|th A|ert

Nat|ona| D|rector, Mr V|ctor Lansana koroma

1oday we are here for an lmporLanL occaslon. PealLh AlerL and
Save Lhe Chlldren are here Loday Lo creaLe a dlscusslon
beLween Lhe communlLy and declslon makers. 1he lree
PealLhcare lnlLlaLlve was launched ln Aprll 2010, and so we are
nearlng Lhe 2
nd
Annlversary of Lhls lmporLanL lnLervenLlon. lL ls
an lmporLanL Llme Lo reflecL on Lhe lnLervenLlon - Lhe
successes and challenges. We Lhlnk lL ls lmporLanL Lo brlng key
players LogeLher, pollcy makers, Lhe communlLy, Lhe people
LhaL represenL us such as Councll Chalrs and Mayors, and also
Lhe lmplemenLers (uMCs). 1oday leL us look aL Lhe lPCl and
how far we have gone, whaL we have achleved, whaL we have
noL achleved, whaL are Lhe challenges. 1he communlLy
members LhaL are presenL here Loday have noL been selecLed
by Save Lhe Chlldren and PealLh AlerL buL by Lhelr communlLy,
and Lhey have also had Llme Lo gaLher feedback and lnpuL from
Lhelr fellow communlLy members. We are noL here Lo flghL,
argue, noL here Lo casL blame, we are here Lo flnd soluLlons,
Lhe way forward for Slerra Leone. 1he lPCl ls noL for AC, SL,
and we are noL here Lo Lalk abouL pollLlcs, we are here Lo
dlscuss developmenL, Slerra Leone movlng forward. We have
wlLh us represenLaLlves from lnCCs and lnLernaLlonal donors.
We are here Lo learn, Lo share experlences. Welcome.

Cpen|ng Address from M|n|stry of nea|th and San|tat|on

D|rector keproduct|ve and Ch||d nea|th, Dr SAS kargbo

lf we Lalk abouL lPCl lLs noL abouL Lhe resldenL, MlnlsLer,
pollLlcs, lL ls abouL Lhe beneflL of ordlnary Slerra Leoneans. lf
people can reflecL how Lhe healLh sLaLus was before Lhe lPCl, lL
was dlfflculL Lo access servlces because of Lhe cosL lnvolved, lL
was a burden on people. We are graLeful Lo our parLners who
have helped Lo llfL Lhe burden provldlng new hope, changlng Lhe
llfe of women and chlldren. lor me personally, Lhe lPCl concerns
Lhe counLry, and l would llke Lo Lhank Lhe CSCs for supporLlng
Lhe lPCl ln Lhe area of educaLlng people, seLLlng expecLaLlons
and puLLlng Lhe messages lnLo pracLlce. 1hls ls a dream LhaL we
should noL allow Lo dle. l am happy abouL Lhe lnlLlaLlve of PealLh
AlerL and Save Lhe Chlldren, people comlng LogeLher Lo have a
dlalogue, Lo crlLlque, Lo evaluaLe - look aL success and how Lo
make lL beLLer. l would cauLlon people LhaL when looklng aL Lhe
challenges we look closely aL whaL led Lo Lhe challenges. We
musL all come LogeLher Lo flnd soluLlons. l do noL wanL Lo say
much more, l am happy Lo be here, Lhank you Lo all of you for
your parLlclpaLlon.

Cn behalf of Lhe MlnlsLry declares Lhe sesslon open.
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D|str|ct 1est|mon|es

rlor Lo aLLendlng Lhe ubllc Pearlng, communlLy represenLaLlves from each of Lhe 14 ulsLrlcLs were asked
Lo prepare a shorL reflecLlon on Lhe experlence of Lhe lPCl ln Lhelr ulsLrlcL. 1hls reflecLlon was Lo be
developed vla broader communlLy consulLaLlon, Lhe communlLy represenLaLlves from each ulsLrlcL belng
glven Lhe resources Lo underLake radlo dlscusslons Lo gaLher feedback from Lhe publlc. WhaL follows ls an
accounL of Lhe oral LesLlmony presenLed by each ulsLrlcL Lo Lhe declslon makers presenL aL Lhe ubllc
Pearlng.

kono D|str|ct

Commun|ty kepresentat|ve: Ioseph Sam Sumana

1he kono 8epresenLaLlve compllmenLed Lhe CovernmenL on lLs efforLs and Lhe achlevemenLs of lPCl,
sLaLlng LhaL Lhe deaLhs of under 3s and pregnanL women has reduced, wlLh more people aLLendlng Lhe
cllnlcs due Lo Lhe absence of flnanclal barrlers. Powever, he also ouLllned key concerns as experlenced ln
kono -

1) PealLhworkers do noL have a good rapporL wlLh Lhe beneflclarles, Lhey don'L Lalk Lo Lhem properly,
and sLaff are ofLen laLe for work,
2) 1he number of healLh personnel ls lnadequaLe, and Lhose LhaL are ln place are ofLen poorly Lralned
or quallfled. 1he represenLaLlve sLaLed LhaL of Lhe 83 Pus ln kono noL all of Lhem have quallLy
healLhworkers,
3) 1he communlLy expecLs key sLakeholders such as Chlefs, Counclllors, and healLhworkers, Lo
underLake senslLlsaLlon on Lhe lPCl, Lo Lalk Lo communlLy members, however Lhls ls llmlLed and
should be lmproved.

!"#$#%&'() *) $+,'-) .*/) 01234+&) &2) 52,-3) 62/7,&*') .,&+) *) 137&31#-) 81*$&31#) *%-) .*/) ,99#-,*&#'()
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&2) &+#) /#$2%-*1() +#*'&+$*1#) 8*$,',&,() .+2) *1#) ,%) $+*14#) &2) 712@,-#) *903'*%$#) *%-) 83#';) A72%)
*11,@*'B) &+#) 9#-,$*') /37#1,%&#%-#%&) .*/) %2&) *123%-B) &+#() &1*$C#-) +,9) -2.%) 0() 920,'#) *%-)
#D7'*,%#-) &+#) /,&3*&,2%;) <+#) /37#1,%&#%-#%&) $*9#) &2) &+#) /$#%#) *%-) 712@,-#-) &+#) *903'*%$#)
+2.#@#1) &+#1#) .*/) %2) 83#') */) &+#() +*@#%E&) 1#$#,@#-) 83#') 821) &+#) 8,1/&) F3*1&#1) 8129) &+#) =,/&1,$&)
G23%$,';) <+#) /37#1,%&#%-#%&) */C#-) -2$&21/) ,%) &+#) +2/7,&*') &2) $2%&1,03&#) 92%#() &2) 731$+*/#) &+#)
83#'B).+,$+)&+#()-,-;)A%821&3%*&#'(B)&+#)$+,'-)'2/&)+,/)',8#),%)&+#)712$#//;H)

kono kepresentat|ve:
Why has Lhe consLrucLlon of Lhe hosplLal, especlally Lhe under 3 parL, sLopped? WhaL ls Lhe relaLlonshlp
beLween Lhe uMC and Lhe Mayor?

Mayor's kesponse: 1he laboraLory ln Lhe hosplLal has been rehablllLaLed. A problem wlLh
decenLrallsaLlon ls LhaL lf Lhe cenLral governmenL ls awardlng Lhe conLracL for Lhe bulldlng of Lhe hosplLal
Lhen Lhey musL be responslble for monlLorlng Lhls, noL Lhe Councll or Lhe Mayor. lf Lhe money had been
glven Lo Lhe kono Councll Lhen Lhey could monlLor Lhe process more effecLlvely. 1he deaLh of Lhe chlld
was unforLunaLe buL aL LhaL Llme Lhe Councll dld noL have money Lo fuel Lhe vehlcle.
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ka||ahun D|str|ct

Commun|ty kepresentat|ve: Mohammed 8r|ma

1he kallahun 8epresenLaLlve applauded PealLh AlerL, Save Lhe Chlldren and Lhe MlnlsLry of PealLh for Lhe
ubllc Pearlng. kallahun noLed a number of lmprovemenLs as a resulL of Lhe lPCl, sLaLlng LhaL Lhe lnfanL
morLallLy raLe had reduced drasLlcally due Lo lncreased access Lo healLh faclllLles, LhaL Lhe number of
ambulances had lncreased, and LhaL as a resulL of senslLlsaLlon, Lhe number of referrals by 18As had also
grown. Powever, Lhe kallahun 8epresenLaLlve ouLllned a range of concerns ln relaLlon Lo Lhe lPCl -

1) lnadequaLe number of healLh personnel - ln mosL places sLaff are llmlLed ln number,
2) LaLe dellvery of drugs - medlclne does noL arrlve on Llme,
3) 18As are noL commlLLed Lo Lhelr work due Lo Lhe lack lncenLlves,
4) PealLhworkers are noL commlLLed or happy due Lo Lhe lncreased number of paLlenLs,
3) eople come from nelghbourlng counLrles Lo beneflL from Lhe lPCl, whlch places an exLra burden
on healLhworkers.

1he kallahun 8epresenLaLlve suggesLed LhaL movlng forward, clear flnanclal lncenLlves should be provlded
Lo 18As (beyond Lhe 8l whlch ls dlscreLlonary), lPCl drugs musL be provlded on Llme and esLlmaLes be
revlsed Laklng lnLo accounL Lhe lmpacL of nelghbourlng counLrles, and LhaL volunLeers supporLlng Lhe lPCl
should be puL lnLo Lhe sysLem and made permanenL sLaff.

kenema D|str|ct

Commun|ty kepresentat|ve: Iedr|ka koroma

1he kenema 8epresenLaLlve was exLremely appreclaLlve of Lhe lPCl sLaLlng LhaL kenema had seen an
lncrease ln Lhe number of people aLLendlng faclllLles, and lmprovemenL ln morLallLy raLes. She also sLaLed
ka||ahun kepresentat|ve:
CLher counLrles are comlng ln Lo access lPCl drugs. Pow wlll we sorL Lhls ouL?

kesponse from Deputy Counc|| Cha|r: 1he lmpacL of nelghbourlng counLrles on Lhe lPCl ls an
acuLe problem, prevlously Lhe kallahun Councll has Lrled Lo speak Lo CovernmenL Lo resolve Lhe
lssues. 1he Councll has also lnvolved Lhe ulsLrlcL SecurlLy CommlLLee Lo deal wlLh Lhe lssue, very
dlfflculL due Lo same languages and Lrlbal groups.

A member of Lhe audlence suggesLed LhaL Lo address Lhe cross-border lssue faclllLles should ask
paLlenLs for relevanL documenLs such as lu cards. 1he Councll 8epresenLaLlve re[ecLed Lhls ldea
as lL could become a barrler for oLher vulnerable groups.

ka||ahun kepresentat|ve:
ComplalnLs are comlng from ambulance drlvers ln kallahun LhaL Lhere ls a lack of fuel for Lhe
vehlcles, and even changlng oll ls a problem. Where do Lhe funds come for ambulance?

kesponse from Deputy Counc|| Cha|r: 1he Councll 8epresenLaLlve expressed surprlse LhaL Lhe
Councll ls noL provldlng Lhe fuel for Lhe ambulance, Lhey have noL recelved complalnLs abouL Lhls
prevlously. 1here has been a CommlLLee formed wlLh all sLakeholders Lo oversee Lhe dally
runnlng of Lhe ambulances. 1he represenLaLlve promlsed LhaL when he goL back Lo kallahun he
would meeL wlLh Lhe ambulance commlLLee Lo lnqulre abouL Lhe problem.
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LhaL donors such as l8C were worklng hard, and LhaL Lhe ambulance referral sysLem had lmproved
slgnlflcanLly as a resulL. Powever, Lhe represenLaLlve shared a number of concerns ln relaLlon Lo Lhe lPCl -

1) lnsufflclenL drugs provlded - whaL ls on Lhe llsL ls ofLen noL ln Lhe cllnlc, or noL ln adequaLe
quanLlLy,
2) arLlcular concern LhaL lv flulds are noL lncluded ln Lhe drugs belng supplled,
3) 1here ls an lnsufflclenL number of healLh personnel Lo cover all 121 Pus, parLlcularly Lhose LhaL
are more rural,
4) needs Lo be more focus on senslLlsaLlon and awareness ralslng, Lhe maln Lowns have knowledge of
Lhe lPCl, buL more aLLenLlon needs Lo be glven Lo Lhe vlllages.

8onthe D|str|ct

Commun|ty kepresentat|ve: Mohammed Sher|ff

1he 8onLhe 8epresenLaLlve ldenLlfled a number of successes of Lhe lPCl - Lhe rehablllLaLlon of Lhe MaLLru
!ong PosplLal, lncludlng Lhe lnsLalmenL of solar panels, Lhe ouLreach LhaL healLhworkers are dolng
parLlcularly glven Lhe challenges of 8onLhe ulsLrlcL, lncreased referrals by 18As, and ongolng senslLlsaLlon
of Lhe lPCl by Save Lhe Chlldren and PealLh AlerL. Powever, a number of concerns were also expressed by
Lhe 8onLhe 8epresenLaLlve -

1) Concern abouL securlLy of Lhe lPCl drugs, wlLh drugs belng sLolen by healLh sLaff ln one Chlefdom,
2) SlgnlflcanL undersLafflng desplLe Lhe facL LhaL Lhere ls a school of nurslng ln MaLLru !ong where
Lhey Lraln 100 nurses - ldenLlfled poor recrulLmenL as Lhe cause of Lhe problem,
3) roblemaLlc drug dlsLrlbuLlon requlrlng boLh vehlcles and boaLs,
4) luel dlsLrlbuLlon ls ofLen noL on Llme, Lhls means LhaL paLlenLs are ofLen Lold Lo buy fuel for
vehlcles,
3) Consumables for Pus and hosplLals are ofLen lnsufflclenL or presenL aL all - wlLh 11,000 people on
Lhe lsland and 26,000 on Lhe malnland, Lhe MoPS need Lo conslder Lhls ln dlsLrlbuLlon of
consumables and drugs,
6) need for a speclal budgeL for people Lo donaLe blood.

8onthe kepresentat|ve: 1here are Lwo hosplLals ln 8onLhe, buL [usL one docLor aLLendlng Lo everyLhlng.
1here should be a memorandum ln place beLween Lhe u8C (prlvaLe hosplLal) and CovL ln Lhe area of
provldlng lPCl.

kesponse (MonS): u8C ls a mlsslon hosplLal. When lPCl was lnLroduced lL was only exLended Lo
CovernmenL faclllLles, however because of Lhe pecullar slLuaLlon ln 8onLhe, Lhe MoPS ls supporLlng Lhe
mlsslon hosplLal. Powever, whlle Lhe MoPS ls provldlng some supporL Lhey cannoL do everyLhlng for Lhe
hosplLal as Lhey are noL supporLlng oLher mlsslon hosplLals. 1he people of 8onLhe need Lo make a
declslon abouL wheLher u8C should be fully lncluded ln Lhe lPCl, and lnfluence CovernmenL accordlngly.

8onthe kepresentat|ve: When Lhe budgeL ls developed Lhe CovernmenL needs Lo look aL Lhe Lerraln, and
Lhe need for boaLs ln 8onLhe. AL Lhe momenL Lhe boaL does noL belong Lo hosplLal or governmenL, and
donors need Lo provlde fuel. 1he supply of drugs Lo Lhe CovL PosplLal ls hlgher buL Lhe prlvaLe hosplLal
has a blgger populaLlon. A number of reporLs have been made Lo Lhe MoPS on Lhls lssue.

kesponse: 1he Local CovL llnance uepL deLermlnes ulsLrlcL allocaLlons based on populaLlon and number
of Pus, also looklng aL equlLy, and vulnerablllLy. AL Lhe momenL Lhe CovernmenL ls LreaLlng Lhe hosplLal
on Lhe malnland as parL CovL faclllLy because of Lhe lPCl, however lL ls Lhe declslon of 8onLhe people Lo
brlng Lhe lssue Lo governmenL on Lhe way forward of Lhe mlsslon hosplLal.
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Moyamba D|str|ct

Commun|ty kepresentat|ve: Mar|e Mustapha

1he Moyamba 8epresenLaLlve was graLeful for Lhe new hosplLal, also sLaLlng LhaL due Lo senslLlsaLlon
pregnanL women ln hard Lo reach areas are now belng referred Lo healLh faclllLles, and an ambulance ls
avallable Lo collecL people. Powever, Lhe represenLaLlve shared a number of challenges ln relaLlon Lo Lhe
lPCl ln Moyamba -

1) MalnLenance of ambulances ls slow resulLlng ln Lhem ofLen noL belng avallable,
2) lPCl urugs are noL sufflclenL, so paLlenLs are ofLen Lold Lo purchase drugs,
3) undersLafflng - nurses and docLors are lnsufflclenL ln number,
4) lollow up ls lneffecLlve - Pus are supposed Lo reporL Lo Lhe CovernmenL PosplLal aL Lhe end of Lhe
monLh, however Lhere ls no/delayed follow up by uPM1 Lo address Lhe lssues ouLllned ln Lhe
reporL.

1he 8epresenLaLlve suggesLed LhaL ln movlng forward Lhe MoPS should lncrease Lhe quanLlLy of drugs aL
cllnlcs so LhaL beneflclarles can geL whaL Lhey are enLlLled Lo, and LhaL Lhe ulsLrlcL Councll should lnclude
budgeL for provlslon of flnanclal lncenLlves Lo blood donors.

AL Llmes Lhey wlll refer cases of malnuLrlLlon buL Lhere ls no vehlcle Lo Lake Lhe cases.


u[ehun D|str|ct

Commun|ty kepresentat|ve: nawa Swaray

1he u[ehun 8epresenLaLlve was graLeful Lo CovernmenL and donors for Lhe lPCl, sLaLlng LhaL Lhere was
now proper handllng and managemenL of emergencles and newborn care such as caeserlan secLlons and
resuslLaLlon, good coordlnaLlon beLween uPM1 and nCCs operaLlng ln Lhe ulsLrlcL, and lmproved blood
and laboraLory. She also lnformed Lhe group LhaL u[ehun has Lhree lnLernaLlonal docLors, and new
ambulances donaLed by unlCLl. Powever, Lhe challenges ldenLlfled were as follows -

1) More medlcal equlpmenL ls requlred, ln parLlcular, Lhere ls [usL one oxygen machlne. 1hey are also
requlre more sLaLlonery and paLhographs.
2) lnadequaLe supply of drugs, parLlcularly anLlbloLlcs.
3) lneffecLlve communlcaLlon beLween Pus (neLwork coverage lssues),
4) 1he road neLwork lmpacLs Lhe referral sysLem, especlally people LhaL are behlnd Lhe waLer,
3) no by-laws for Lhe communlLy, as such dellverles by 18As are sLlll golng on,
6) WaLer supply ls noL effecLlve ln Lhe hosplLal, especlally ln Lhe maLernlLy unlL,
7) Appeallng Lo Lhe Councll Lo make provlslon for flnanclal lncenLlves for blood donors.
Moyamba kepresentat|ve:
1he 8epresenLaLlve was concerned abouL sLaff quarLers, sLaLlng LhaL Lhey were ln deplorable
condlLlon. WhaL wlll Lhe councll and uMC abouL Lhls?

kesponse: 1he Councll ls aware of Lhe problem and has been Lo vlslL Lhe places Lo look aL
rehablllLaLlng Lhe houses menLloned, Lhe relevanL documenLs have been prepared and are awalLlng
approval by Lhe uMC.
!
! )!

8o D|str|ct

Commun|ty kepresentat|ve: nannah koroma

1he 8o 8epresenLaLlve sLaLed LhaL as a resulL of Lhe lPCl 8o has seen lncreased AnC aLLendance, lmproved
awareness amongsL Lhe publlc, more commlLLed healLhworkers, and a cleaner and more comforLable
hosplLal. Powever, she also llsLed a number of problems wlLh Lhe lmplemenLaLlon of Lhe lPCl ln 8o -

1) ShorLage of some essenLlal drugs,
2) lnsufflclenL number of healLh sLaff Lo cover all of Lhe Pus.
3) 8eferral sysLem ls poor due Lo bad road neLwork,
4) WaLer and sanlLaLlon ls an lssue aL Pu level - appealed Lo nCCs Lo esLabllsh more waLer pumps
and handwells aL faclllLles,
3) Lack of sLaff quarLers,
6) Lack frldge ln some cllnlcs.

1he 8epresenLaLlve suggesLed LhaL ln fuLure Lhere should be more drugs and dellvered on Llme, and more
ambulances as Lhere are 13 chlefdoms wlLh parLlcularly bad roads. She also appealed Lo Lhe Councll Lo
address Lhe bad road neLwork. llnally, she asked LhaL more lncenLlves be provlded for healLhworkers, and a
dlrecL flnanclal lncenLlve be glven Lo 18As.
ko|nadugu D|str|ct

Commun|ty kepresentat|ve: ka| August|ne Ghand|

1he kolnadugu 8epresenLaLlve was appreclaLe of CovernmenL for Lhe lPCl calllng for lL Lo be exLended. 1he
8epresenLaLlve dld however polnL Lo a humber of challenges experlenced ln kolnadugu ln relaLlon Lo Lhe
lPCl -
1) urugs are llmlLed, many beneflclarles go Lo Lhe cllnlc and are Lold by Lhe ln charge LhaL Lhe drugs
have run ouL meanlng LhaL paLlenLs have Lo buy drugs. Pe also sLaLed LhaL Lhe drugs generally run
ouL well before reLurns Llme,
2) 1he drugs provlded do noL always maLch up Lo Lhe relevanL slcknesses, for example Lhere are ofLen
drugs provlded for hyperLenslon when hyperLenslon ls noL an lssue ln kolnadugu,
3) 1here ls only one funcLlonal ambulance - ln Lhe case of opo Chlefdom whlch ls 110 mlles from
kabbalah, lL ls lmposslble Lo brlng someone Lo Lhe hosplLal,
4) CSCs should lncrease monlLorlng.
3) oor aLLlLude of healLhworkers - you go Lo cllnlc wlLh an emergency case and healLhworkers can be
exLremely aggresslve - furLher lncenLlves and remoLe allowances are needed.
6) SenslLlsaLlon Lo counLer LradlLlonal bellefs musL be sLrengLhened - for example, recenLly a lullah
women came Lo Lhe cllnlc as she was ln labour buL dld noL allow Lhe nurse Lo Louch her because he
was a man.

8o Counc|| (cha|rperson for hea|th): eople say nurses LreaL people badly, buL also some communlLy
people can be very dlfflculL Lo work wlLh. 1he communlLy can cause loLs of problems, recenLly l had Lo go
and seLLle a dlspuLe, a communlLy member had lled LhaL Lhe MCP Alde had sLolen Lhe drugs.
PealLhworkers make sacrlflces, we need Lo encourage Lhem, lf we frusLraLe Lhem Lhey can be hard Lo
replace. Appeallng Lo Lhe MoPS Lo repalr, erecL sLaff quarLers.

!
! *+!
8omba|| D|str|ct

Commun|ty kepresentat|ve: Iayne kamara

1he 8omball 8epresenLaLlve applauded Save Lhe Chlldren and PealLh AlerL for lnlLlaLlng Lhe ubllc Pearlng.
1he 8epresenLaLlve sLaLed LhaL due Lo Save Lhe Chlldren and PealLh AlerL awareness of Lhe lPCl had
lmproved ln 8omball, Lhe lPCl had broughL abouL an lncrease ln Lhe number of healLh faclllLles, more
Lralned personnel, and lncreased access. Powever, she also ldenLlfled a number of concerns regardlng Lhe
lmplemenLaLlon of Lhe lPCl -

1) 8eferrals by 18As are low due Lo dlsLance from cllnlcs,
2) 18As are sLlll dellverlng pregnanL women because Lhe women Lhemselves prefer 18As due Lo Lhe
aLLlLude of healLhworkers,
3) lnadequaLe blood supply,
4) ulsLance for paLlenLs Lo Pus,
3) Mlsuse of drugs by beneflclarles.

1he 8epresenLaLlve sald LhaL ln movlng forward Lhe MoPS should lncrease Lhe supply of drugs, on Llme,
posL more Lralned nurses Lo Pus, provlde refresher Lralnlng for nurses on aLLlLude Lowards paLlenLs, bulld
more Pus, lmprove monlLorlng and supervlslon of healLhworkers, provlde a funcLlonal sLandby generaLor
for Lhe hosplLal, and a sLockplle of fuel for Lhe ambulance for emergency cases.

1onko|||| D|str|ct

Commun|ty kepresentat|ve: Memuma 1okonona

1he 1onkolllll 8epresenLaLlve applauded Lhe CovernmenL for Lhe lPCl sLaLlng LhaL Lhe lnfanL and maLernal
deaLh raLe had reduced, and LhaL prevlously women were scared Lo go Lo Lhe hosplLal because of Lhe
money buL Lhls has dlsslpaLed and now Lhey go Lo faclllLles Lo geL medlclne and operaLlons for free.
Powever, Lhe 8epresenLaLlve also ouLllned a number of problems wlLh lmplemenLaLlon -

1) MlsundersLandlng by beneflclarles LhaL whenever Lhey go Lo Lhe hosplLal Lhey should recelve drugs,
leads Lo quarrels wlLh healLhworkers. 8eneflclarles need lmproved undersLandlng of Lhe
LreaLmenLs requlred for varlous slcknesses,
2) oor road neLwork ln 1onkolllll means LhaL lL can be hard Lo geL emergency cases Lo hosplLal,
3) Lack of fuel for ambulances - ofLen Llmes sLaff aL Pu level call Lhe ambulance drlvers and Lhey are
Lold LhaL Lhere ls no fuel for Lhe ambulance.
4) Challenges wlLh 18As referrlng cases, however slLuaLlon has lmproved due Lo unlA provldlng
lncenLlves Lo 18As,
3) Councll needs Lo lnclude a budgeL llne for flnanclal lncenLlves for blood donors.

1he 8epresenLaLlve suggesLed LhaL Lhe phone numbers of Lhe ambulance drlvers be senL Lo all healLh
cenLres Lo enable referral of cases.

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,%) $1,&,$*') $2%-,&,2%) ,%) *) +*992$C;) <+#) %31/#) 2%) -3&() .*/) %2&) *0'#) &2) $2%&*$&) &+#) *903'*%$#)
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*903'*%$#)/2)7120'#9/)',C#)&+,/)-2)%2&)+*77#%)*4*,%H)

! **!
ort Loko D|str|ct

Commun|ty kepresentat|ve: Abdu| 8angura

1he orL Loko 8epresenLaLlve LhaL uLlllsaLlon of healLh servlces had lncreased due Lo senslLlsaLlon by Save
Lhe Chlldren and PealLh AlerL, lnfanL morLallLy has reduced, and healLhworkers aL Lhe CovernmenL hosplLal
are more effecLlve ln Lhelr work because of supervlslon. 1he 8epresenLaLlve also sLressed LhaL Lhe
CovernmenL PosplLal had been lmproved, wlLh an addlLlonal 40 beds for women and chlldren, and an
addlLlonal drug sLore and sLaff quarLers bullL. Powever, Lhere have also been slgnlflcanL challenges ln Lhe
lmplemenLaLlon of Lhe lPCl ln orL Loko -

1) lnablllLy Lo dlfferenLlaLe beLween lPCl drugs and cosL recovery drugs, Lhere ls only one dlspenser
for boLh seLs of drugs and all are kepL ln one cupboard,
2) 1here ls no x-ray or scannlng machlne whlch causes delays ln dellvery,
3) aLlenLs are requlred Lo buy admlsslon charLs,
4) uelay ln drug dlsLrlbuLlon - ln Lhe case of some Pus drugs do noL reach aL all due lssues wlLh Lhe
councll releaslng money Lo pay for fuel for vehlcle Lo dlsLrlbuLe drugs,
3) PealLhworkersdo noL Lalk nlcely Lo paLlenLs, so paLlenLs are becomlng scared Lo aLLend faclllLles.

1he 8epresenLaLlve had a number of recommendaLlons movlng forward -
MoPS needs Lo lnLenslfy monlLorlng ln relaLlon Lo drugs, so people geL whaL Lhey are meanL Lo geL,
needs Lo be conLlnuous awareness ralslng of Lhe lPCl because people forgeL,
More drugs so as Lo cuL across all Lhe slcknesses LhaL lPCl beneflclarles experlence,
MoPS need Lo raln and recrulL more healLhworkers so LhaL servlce dellvery wlll be more effecLlve
and efflclenL,
aedeaLrlc uocLor ln orL Loko has been absenL for 2 monLhs wlLh no replacemenL,
A speclal blood bank ls requlred - people geL Lold Lo buy blood and so people dle.


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'2/&) &+#) 0*0(;) L31/#/) &2'-) &+#) .29#%) &+#() .23'-) -2) /29#) $'#*%,%4) *%-) &+*&) /+#) +*-) &2) 7*()
MNOBOOO) P#2%#/) 821) #@#1(&+,%4;) Q29#%) 0#44#-) &2) 7*() R3/&) SOBOOO) P#2%#/;) <+#) G+,#8) $*''#-) &+#)
.29#%)*%-)%31/#)0#$*3/#),&).*/)$'#*1)&+*&)&+#).29#%)-,-)%2&)3%-#1/&*%-,%4)&+*&)/+#).*/)%2&)
9#*%&)&2)7*()*%(&+,%4)*&)*''B)+#)&22C)+#1)&2)&+#)6#*'&+)K'#1&):2$*')T#1/2%)*%-)&+#()$+*''#%4#-)
&+#),//3#;H)

kamb|a D|str|ct

Commun|ty kepresentat|ve: Ioday S. S. Dumbuya

1he kambla 8epresenLaLlve sLaLed LhaL Lhe level of awareness of Lhe lPCl had lncreased, commlLmenL by
healLhworkers had lmproved, drug supply ls also on course, maLernal and lnfanL morLallLy has dropped due
Lo acLlons Laken by healLh personnel, monlLorlng by CSC has been poslLlve, lncreased salarles for
healLhworkers has conLrlbuLed Lo maklng healLhworkers more effecLlve and efflclenL, reducLlon ln
counLerfelL drugs, lmprovemenLs ln number of cases referred Lo hosplLals. Powever, Lhe 8epresenLaLlve
was concerned abouL Lhe followlng lssues -

1) Large number of volunLeers worklng ln Lhe varlous healLh faclllLles and Lhey are noL commlLLed Lo
dellverlng quallLy healLh servlces,
2) 1he supply of drugs ls ofLen laLe,
3) 1he upLake of lPCl by nelghbourlng counLrles has had an lmpacL on Lhe workload of sLaff and
quanLlLy of drugs avallable.
! *"!

Western Area kura|

Commun|ty kepresentat|ve: Iat|ma Webber

1he WesLern Area 8ural 8epresenLaLlve was graLeful for Lhe opporLunlLy Lo parLlclpaLe ln Lhe ubllc
Pearlng. 1he 8epresenLaLlve sLaLed LhaL as a resulL of Lhe lPCl lnfanL and maLernal morLallLy raLes had
reduced, and awareness had lncreased amongsL pregnanL women of Lhe lPCl. Powever, Lhe
8epresenLaLlve clLed a number of challenges ln relaLlon Lo Lhe lPCl ln WesLern 8ural Area -

1) lncreased dellverles amongsL Leenage glrls, parLlcularly ln WaLerloo, and some of Lhe flshlng areas,
2) ALLlLude of medlcal personnel - nurses speak harshly Lo paLlenLs,
3) 8lg lmpacL from PealLh lor All CoallLlon ln WesLern Area - namlng and shamlng people.

1he 8epresenLaLlve suggesLed LhaL ln movlng forward CSCs worklng ln WesLern 8ural Area should be more
collaboraLlve Lo ensure greaLer success, Lhe MoPS should ensure LhaL an ambulance resldes ln WesLern
8ural Area, and LhaL Lhe Councll needs Lo make provlslon for flnanclal lncenLlves for blood donors.

Western Urban

Commun|ty kepresentat|ve: au| 8angura

1he WesLern urban 8epresenLaLlve sLaLed LhaL Lhe removal of user fees has encouraged more people Lo go
Lo hosplLal resulLlng ln a reducLlon of lnfanL and maLernal morLallLy raLes. Powever, he also ldenLlfled a
number of challenges ln relaLlon Lo lmplemenLaLlon -

1) CongesLlon ln hosplLals due Lo llmlLed capaclLy,
2) PealLh sLaff behave badly Lo paLlenLs - shouL aL Lhem, quarrel (CoLLage),
3) Lack of lPCl drugs so mosL people are glven prescrlpLlons,
4) oor waLer supply sysLem - Lhere are some Pus ln Lown LhaL don'L have enough waLer, and ask
paLlenLs Lo buy waLer Lo wash bables,
3) eople llvlng ln mounLaln areas flnd lL dlfflculL Lo come down Lo healLh faclllLles, need Lo be made
more accesslble,
6) AllegaLlons LhaL some healLh sLaff sLlll demand money secreLly.

Western kura| kepresentat|ve:
ln kenema Lhe blood donor group has supporL from Councll, Lhls ls noL Lhe case ln oLher ulsLrlcLs.
Why are all Counclls noL provldlng flnanclal lncenLlves for blood donors?

kesponse: In some |nstances there are Lled budgeLs prevenLlng provlslon for such Lhlngs,
however Lhe represenLaLlve should conLacL Lhe uMC Lo look lnLo lL. and Counclls should slL
LogeLher and plan Lhelr budgeLs.

u[ehun Counc|| kepresentat|ve:
8evenue dlffers for each ulsLrlcL, counclllors wlll bulld schools and roads, nobody wlll appreclaLe
Lhe purchase of drugs or Lhe creaLlon of a budgeL llne for blood donors. 1he MlnlsLry of PealLh
should be encouraged Lo cover blood, lL should be lncluded ln Lhe budgeL aL cenLral level.
!
! *#!

Spec|f|c Issues for D|scuss|on

1. Att|tude of nea|thworkers:

1onko||||| kepresentat|ve: Some sLaff have a bad aLLlLude, however from my experlence Lhe uPM1s and
Counclls have puL a loL of Lhlngs ln place. ln some lnsLances where we geL complalnLs abouL aLLlLude, we go
Lo Lhe Pu Lo lnvesLlgaLe and Lhe paLlenLs slng pralses, and vlce versa. 1he communlLy has a key role Lo
play ln Lhls lssue. We have Lo recognlse LhaL ln some places we flnd lL dlfflculL Lo geL quarLers for sLaff or
Lhe communlLy falls Lo provlde securlLy for sLaff, all of Lhose lnfluences sLaff aLLlLude. lor example, 2
monLhs ago a nurse opened her door and was aLLacked by people. Also ln many lnsLances Pus only have
one sLaff each, lmaglne lf you are Lhere, and you cannoL geL slck or Llred worklng 24 hours seven days a
week.

ka||ahun kepresentat|ve: CovernmenL needs Lo provlde faclllLles for healLhworkers, make more dlfflculL
locaLlons lnhablLable, provlde remoLe allowances, provlde securlLy for healLhworkers. We also need Lo
resolve Lhe lssue of volunLeerlsm, Lhere are volunLeers LhroughouL Lhe sysLem, and aL Lhe end of Lhe monLh
Lhey don'L geL a salary. 1hey need Lo be absorbed lnLo Lhe sysLem.

2. Drug Supp|y:

Commun|ty kepresentat|ve: MlnlsLry of PealLh need Lo conLlnue Lo Lraln personnel on LMlS, and loglsLlcs
managemenL. ln addlLlon Lo Lhls, Lhere ls no separaLe place Lo puL cosL recovery and lPCl drugs, exLenslon
of Lhe drug sLores would help enable effecLlve managemenL of drugs.

MonS - D|rector of kCn: 1here should be no confuslon arlslng from Lhe Lwo klnds of drugs. lf Lhey are cosL
recovery drugs people are expecLed Lo pay a percenLage of Lhe cosL. lf lPCl drugs flnlsh Lhen people have
Lo Lake oLher drugs. All are governmenL drugs, Lake from governmenL Lo accompllsh CovL pollcy.

Dr 8ah: lf someone glves you 100 mllllon leones lL wlll never do for you, everyone ls Lrylng, when drugs are
noL Lhere healLhworkers bear Lhe brunL. lPCl drugs and cosL recovery should go slmulLaneously, lf lPCl
drugs are Lhere Lhen Lhere should be no problem, lf however Lhey run ouL people wlll have Lo purchase
cosL recovery drugs. AdequaLe drugs are needed. ln many places Lhere are only Lwo labourers aL Lhe sLore,
how do we offload Lhe drugs wlLh such llmlLed asslsLance, we need more sLaff Lo manage sLores.

ko|nadugu kepresentat|ve: 1he money from Lhe cosL recovery drugs should go dlrecLly Lo uPM1, Lhen
Councll ls made responslble for monlLorlng uLlllsaLlon of funds for cosL recovery drugs, raLher Lhan
devolvlng dlrecLly Lo hosplLals.

MonS: 1he MoPS ls responslble for decldlng Lhe quanLlLy of drugs Lo be provlded Lo faclllLles, however
faclllLles are sLlll noL adequaLely accounLlng for drugs so lL ls dlfflculL Lo know whaL ls requlred. We also
need Lo undersLand consLralnLs, Lhere ls noL enough manpower Lo counL drugs as well as respond Lo
paLlenLs. 1hls ls why Lhe MoPS ls drawlng on employed Leachers Lo asslsL healLh sLaff ln fllllng ouL reporLs -
communlLy should also asslsL wlLh Lhls process.

3. Water and San|tat|on:

Commun|ty kepresentat|ve: 1he cholera ouLbreak has been due Lo waLer lssues. Whlle many faclllLles have
waLer wells Lhey are noL ln good order. Slmllarly, whlle chlorlne ls provlded lL ls ofLen ln lnsufflclenL
quanLlLles.

! *$!
Western kura| kepresentat|ve: 1he Councll conLracLed someone Lo run a plpe dlrecL from Lhe dam, buL
people sLeal Lhe waLer. ln addlLlon Lo Lhls money has been glven Lo Lhe ulsLrlcL Councll from World 8ank for
rehablllLaLlon buL sLlll Lhe communlLy have noL recelved Lhe waLer. 1here used Lo be money for Pus called
malnLenance money, Lhls has now been replaced by Lhe 8l and lL ls unclear wheLher malnLenance ls
lncluded. lf lL was Lhere lL would help a loL.

8omba|| kepresentat|ve: 1he Councll needs Lo send lnformaLlon Lo Lhe SL8A LhaL whenever Lhey do road
consLrucLlon Lhey should lL wlLh SLAWACC so rellable waLer can be broughL.

ko|nadugu DMC: 8efore Lhls Llme Lhey pald cash Lo faclllLles, 1 mllllon leones. CovernmenL changed Lhls Lo
Lhe 8l, crlLerla ls Lhere - assessmenL Leam from cenLral level LhaL go Lo all Lhe Pus Lo see how Lhey meeL
Lhe crlLerla.

4. Ambu|ances

Moyamba kepresentat|ve: Moyamba has only one ambulance Lo cover 14 Chlefdoms and ofLen Llmes lL
breaks down. Appealed Lo LhaL Lhe MlnlsLry LhaL an addlLlonal ambulance be provlded.

Western kura| kepresentat|ve: 1hls ulsLrlcL had no ambulance, Lhe MlnlsLry needs Lo send an ambulance
Lo WaLerloo permanenLly. 1here ls also no permanenL docLor.

1onko||||| kepresentat|ve: Appealed Lo Councll Lo send ambulance numbers Lo Pus. vehlcle ls noL belng
used, an old one, consumes Loo much fuel, 3 exLra ambulances, uslng Lhem. MalnLenance, Llmely provlslon
of fuel are key lssues.

8o kepresentat|ve: 8o ulsLrlcL had Lwo ambulances for Lhe blg referral hosplLal, however ofLen one has
gone Lo lreeLown. Appeallng for addlLlonal ambulance.

8onthe Commun|ty kepresentat|ve Moyamba Commun|ty kepresentat|ve
! *%!
C|os|ng kesponse from the M|n|stry of nea|th and San|tat|on
!
Ch|ef Med|ca| Cff|cer, Dr k|s|to Daoh

Cn behalf of Lhe MlnlsLry of PealLh and SanlLaLlon l am graLeful Lo colleagues LhaL have come along way Lo
aLLend Lhe ubllc Pearlng. MlnlsLry offlclals made lL a polnL Lo be here Loday, parLlcularly because of Lhe
efforLs made by uMCs. 1he MlnlsLry have Laken noLe of every recommendaLlon, and Lhe reporL wlll be
Laken back Lo Lhe MlnlsLry Lo look aL how soluLlons can be ldenLlfled for Lhe lssues ralsed. MosL of Lhe
lssues LhaL have been ralsed Loday are belng addressed, and CovernmenL and Lhe MlnlsLry are Lhlnklng
abouL Lhese lssues.

Lverybody presenL Loday from cenLral governmenL Lo local counclls and uMCs and Lhe communlLy have
roles Lo play Lo ensure LhaL healLh ls successful. lL ls everybody's responslblllLy. 1he counclls do Lhelr plans
and send Lhem Lo cenLral level, and Lhen cenLral level send Lhe money Lo supporL. no governmenL can
supporL healLhcare aL 100, LhaL should be clear, we need Lo prlorlLlse lssues relaLed Lo healLh and lssues
LhaL can brlng ouL resulLs.

l would llke Lo respond Lo some of Lhe speclflc lssues ralsed Loday.
1. volunLeerlsm - we currenLly don'L have people ln sufflclenL numbers and LhaL ls why volunLeers
have come, buL we musL ldenLlfy volunLeers LhaL have Lhe poLenLlal Lo be Lralned and have Lhelr
capaclLy bullL, oLherwlse lL wlll noL be posslble Lo absorb Lhem lnLo Lhe sysLem aL a laLer daLe.
2. 8ole of Lhe MlnlsLry - Lhe role of Lhe MlnlsLry ls Lo develop and deslgn pollcles and programmes,
underLake sLraLeglc plannlng, and Lo Lraln Lralners. 1he MlnlsLry needs Lo Lraln Lralners Lo enable
effecLlve monlLorlng of healLhcare dellvery, monlLorlng noL [usL aL Lhe cenLre buL LhaL fllLers down.
3. uecenLrallsaLlon - lL ls parLlcularly lmporLanL LhaL Lhe counclls are lnvolved ln monlLorlng because
Lhe money ls devolved Lo Lhe counclls. Also, lf we wanL Lo do someLhlng llke campalgn for flnanclal
lncenLlves for blood donors, Lhls should be a prlorlLy for Lhe counclls noL Lhe MlnlsLry, some
dlsLrlcLs have Lhe resources, some do noL, buL everybody should be Lhlnklng abouL Lhls.
uecenLrallsaLlon ls a gradual process, lL wonL be perfecL, Lhere are loLs of problems regardlng
capaclLy aL dlsLrlcL level, lack of knowledge on healLh, mosL of Lhe counclllors are noL healLh
pracLlLloners. 1he MlnlsLry ls acLually Lhlnklng of seLLlng up a healLh board aL dlsLrlcL level buL
counclls are reslsLanL.
4. llsLula - lL has been sald Loday LhaL Lhe MlnlsLry has no focus on Lhls, l was one of Lhe flrsL persons
Lo be parL of Lhe flsLula commlLLee.
3. 1ralnlng - we need Lo do a loL more wlLh regard Lo Lhe number of people Lralned, however lL ls noL
so much an lssue of quanLlLy, buL sLandard/quallLy. lrom Lhe assessmenL done Lhe sLandard of
nurslng has dropped, even lf people don'L have Lhe quallflcaLlons, because of pollLlcal lnfluence you
geL a [ob. 1he MlnlsLry ls Lrylng Lo sLop Lhese lnsLlLuLlons Lralnlng nurses. We need Lo Lhlnk abouL
lssue of quallLy of care crlLlcally, noL [usL number of healLhworkers. MosL faclllLles don'L have Lhe
personnel needed, and ln some cases we are Lhlnklng of closlng down faclllLles due Lo lack of sLaff.
6. ulsLrlbuLlon of sLaff - Lhe dlsLrlbuLlon problems are relaLed Lo Lhe number of sLaff we have.
7. ALLlLude of communlLles - we have a loL of lssues where people don'L wanL a parLlcular nurse,
docLor when we are underLaklng recrulLmenL. CommunlLy aLLlLude Loward healLhworkers needs Lo
be one of respecL. lor example, lf you cannoL do Lhe work of soldlers and Lhe person ls a soldler
you need Lo respecL Lhls. arLlcularly where healLhcare provlders are Lransferrlng Lo dlsLrlcLs LhaL
are noL Lhelr own communlLy people should be able Lo accommodaLe sLaff.
8. (8) 18As - we sLlll need Lhem buL ln a dlfferenL role. AlLhough people say 'l was dellvered by 18A
and l survlved', Lhose people LhaL dled due Lo compllcaLlons aL blrLh are noL here Lo speak. Where
pregnanL women are dylng ln Lhe hands of 18As, Lhey are clearly noL playlng Lhelr role - Lhere ls an
audlL happenlng ln every dlsLrlcL, and for every maLernal deaLh Lhey are golng Lo lnvesLlgaLe Lhe
cause.