The ramifications of the just concluded British elections, which saw the defeat of the ruling Labour party and Prime Minister Gordon Brown’s decision to resign as leader of the party pose extremely critical prospective developmental challenges in each the short and medium terms, for the Sierra Leone government and specially the lately rolled out 70 percent British government financed, socialized free of charge wellness care initiative for pregnant girls, breast-feeding mothers and young children under five years together with other DIFD funded programs in the country.
This conclusion is borne from the truth that Gordon Brown and to a lesser extent his predecessor Tony Blair and the Labour party, largely and singlehandedly championed the ideological shift towards elimination of industry based healthcare user fees, in favor of free foreign-aided healthcare, government managed and NGOs, mostly in underdeveloped countries, each in his capacity as the Chancellor of the Exchequer and later as Prime Minister.
Since the policy and program priorities of the new Conservative government and its leadership may nicely be diametrically opposed to the funding programs embarked upon and commitments produced by the Gordon Brown and Tony Blair-led Labour party, it is but prudent and reasonable to postulate that a resultant scaling back or outright cancellation of programs in countries such as Sierra Leone might be inevitable.
Historically, the policies of the Conservative party have been guided largely by jingoistic private enterprise free-market based solutions rather than the socialized aid- based approach of the Labour party to addressing issues of poverty and underdevelopment in third-globe countries. Burdened with large deficits at property and an ideological bent towards the center- appropriate in fiscal policies, Prime Minister David Cameron’s government may possibly seek to reduce commitments overseas as it embarks on cost cutting programs at home to balance its own spending budget. It would for that reason not be surprising to see the axe or substantial curtailment in continued funding of programs, such as the Sierra Leone government free well being care initiative.
The period from independence until the introduction of the Bamako Initiative in 1987 largely saw the practice of government delivered, managed and funded virtual free of charge healthcare, the model in Sierra Leone. The period also witnessed the introduction of “under-5 clinics” throughout government hospitals and clinics exactly where services were delivered free of charge at government expense for pregnant girls and kids below five. Although subsequently poorly managed and succumbing to the vicissitudes of the creeping corruption permeating the nation and the failure to move away from total management by bureaucrats in the Ministry of Wellness and Sanitation of the well being care infrastructure, this program lastly succumbed in the 1970′s and 1980′s as governmental funding precipitously declined.
The Bamako Initiative was therefore the culmination of efforts by African Ministers of Well being in the 1980′s to stem the alarming deteriorating well being indictors witnessed all through the continent, by looking for to inject marketplace-based financing mechanisms in the delivery of healthcare. The ministers signed the Bamako Agreement with the World Well being Organization (WHO) and the United Nations Children’s Fund (UNICEF). This ideological shift in thinking on healthcare financing and delivery promoted the concept that getting patients, specially the economically able to pay for treatment and health services through user-fees would support bring in scarce healthcare resources, generate a much more sustainable delivery industry- based model and improve efficiency.
The genesis of Sierra Leone’s abolition of user-fees for maternal and child wellness services can be traced to the then Chancellor of the Exchequer, Gordon Brown’s declaration that “there must be universal and free of charge schooling and healthcare as the starting of justice for the poorest countries of the globe”. Subsequently as Prime Minister in 2009, Gordon Brown wrote to some of the poorest countries with user fees, such as Sierra Leone providing British government support, both in aid and technical help, to those who wished to abolish the fees.
Sierra Leone a perennial foreign aid-dependant nation instantly jumped on the bandwagon and became on April 27, 2010 the initial of the six countries, that had made a commitment in September 2009 to removing user fees for maternal and child health.
At a UN meeting in September 2009, Prime Minister Gordon Brown pledged to share the British expertise on making free of charge wellness services by way of a new ‘Centre for Progressive Wellness Financing’ which developing countries would be able to turn to for help. The establishment of this center in Britain with employment opportunities for British citizens and serving as the nerve center for NGO participation in Sierra Leone’s healthcare program, is the kicker for the continued reliance of countries who sign up for this so-known as free of charge wellness care to remain financially and politically dependant on the British government for their healthcare policies and an incubator for the socialized healthcare that even the British had been rejecting.
It is therefore not surprising that despite implementation of market based insurance or social insurance based medical healthcare systems and programs in western countries and the United Kingdom itself, Gordon Brown was seeking to sign up creating nations for programs his own society could not fathom or tolerate.
This new program, a component of the country’s six-year strategy to make healthcare free of charge for all vulnerable groups, such as the elderly and the really poor by 2015 is projected to receive £34 million from the British government and is slated to provide free of charge healthcare to about 230,000 women and one million kids, as well as strengthening the healthcare method for the wider population.
As a proponent of cost-free markets and private enterprise solutions to most of Sierra Leone’s perennial underdevelopment problems, I have for numerous years articulated a market-based social insurance program that can efficiently address the inefficiencies, funding and delivery issues in the healthcare method.
The continued dependence on the Ministry of Health and Sanitation for implementation of well being delivery and financing programs is doomed to failure as evidenced from the historical data dating to independence.
As at roll out of the program on April 27, 2010 donor funding was not sufficiently predictable or sufficiently huge enough to support reaching the program’s projected spending budget. Even if efforts to boost the effectiveness of current aid for health are productive, a sharp enhance in resources is necessary. For example, the Sierra Leone government estimates the expense of delivering totally free maternal and child healthcare to be $ 91 million for 2010. By its own admission, there is still a $ 20.1 million shortfall in commitments as of November 2009.
An analysis of the program’s funding reveals that less than fifty percent (44 million dollars) of the budgeted 91 million dollars is for the provision of drugs and medical consumables. The remaining 47 million dollars budgeted is truly for such expenses as governance structures, human resources, communications and monitoring and evaluation.
The government’s total committed funding for this significantly touted totally free well being care program is a paltry 12.5 million representing its total health budget for 2010. It is further note worthy that of the whole 12.five million dollars well being budget, the government’s allocation of 70 percent to the Reproductive Child Health program renders the remaining 30 percent for the entire country’s medical healthcare funding.
The unsustainablity of the totally free user fees policy, particularly for Sierra Leoneans who can afford healthcare and the delayed implementation of a social health insurance method where employers, staff and government all participate renders this existing approach of a government only managed method a false panacea to the inevitable looming disaster.
It is thus hoped that policymakers in the Sierra Leone government not only planned and projected for the ideological tendencies in British politics, as it embarked on the Gordon Brown- induced shift away from the “Bamako Initiative” in healthcare delivery and funding but that it will now proactively seek option funding and social well being insurance mechanisms and models to continue the healthcare reform initiative.
Innovative financing, revolving around new sources and new instruments for raising revenues from at least the financially able Sierra Leone middle class participating in the program, by means of a means- test outside of the tax revenue systems, need to be pursued and implemented to contain mechanisms that will incorporate several industry-based aspects of financing – from additional user funding to the powerful leveraging and use of the already pledged donor funds.