Introduction
Health indicators are quantifiable measures of a population used by researchers, policymakers, governments, and non-governmental organizations to summarize the priority areas to ensure healthy communities. The health indicators differ from country to country depending on a variety of factors, exceptionally economical status. The article explores Sierra Leone as a Web-country of choice.
Web-Country: Republic of Sierra Leone
Sierra Leone is a coastal West African country with its capital city situated in the Freetown city. Liberia neighbors the government to the East, and Guinea to the North and West. The country size is approximately 27699 square miles, with a population of 7396000. Sierra Leone is currently a member of the African Union (AU), and it belongs to the World Health Organization (WHO) Africa region. The World Bank income grouping categorizes the country as Sub-Saharan Low-Income country (LIC). In the last decade, Sierra Leone has been highlighted in global news following the Ebola virus epidemic in 2014-2016. Approximately 8700 people were infected with the deadly virus, with 3590 deaths being recorded over the two years. The country is currently channeling resources to stave off the Coronavirus disease (COVID-19), like the rest of the world.
Key Health Indicators
The Ministry of Health and Sanitation (MoHS) oversees and implements health policies in the Republic of Sierra Leone. Through world partnerships, the MoHS has carried out three Demographic and Health Surveys, including the latest 2019 Sierra Leone Demographics and Health Survey (SLDHS). The other two were conducted in 2008 and 2013. The 2019 SLDHS highlight key health indicators among the people of the Republic of Sierra Leone. Health indicators are fundamental in establishing common diseases within a population, the significant causes of morbidity and mortality, the effect of health policies on improving health status, and surveillance of conditions, including emerging and re-emerging infections. Among the critical health indicators are the Life Expectancy, Maternal Mortality Ratios, and Infant Mortality rates. The health indicators differ from one country to another with differences in the cultural, environmental, economic, and education levels. The social determinants of health, therefore, may influence the outcomes of various health indicators.
Current Statistics
According to the WHO Global Health Observatory (GHO) data, Sierra Leone had a life expectancy at 52 years and 54 years for men and women, respectively, in 2016. The expectancy remains lower than the Sub-Saharan Africa average life expectancy of 57 years. The 2019 SLDHS brief highlights a gradual decline in the early childhood mortality rates in the last decade. The under-5 child mortality rate was 122 deaths per 1000 live births, the infant mortality rate at 75 deaths per 1000 live births, and neonatal mortality rate at 31 per 1000 live births. Despite the reduction in the early childhood mortality rates, the statistics are far from achieving the Sustainable Development Goal (SDG) of 12 deaths per 1000 live births for neonatal and infant mortality rates, and 25 deaths per 1000 live births for under-5 mortality rate. Focusing on increasing the children who receive essential vaccination (56% currently) and advocating for better infant and young child (IYCF) practices offer improvement opportunities. The leading causes of disease burden in this population include malnutrition, malaria, acute respiratory infections, and diarrheal illnesses.
Furthermore, data from the World Bank indicates a gradual decline in the maternal mortality ratio from 2000-2017. In 2017, the maternal mortality ratio in Sierra Leone was estimated at 1120 deaths per 100000 live births. The ratio is far from the SDG goal of fewer than 75 deaths per 100000 live births by 2030. Notably, the decline can be attributed to improved maternal care with an increased proportion of pregnant women giving birth in health facilities, receiving care from skilled labor, and rising antenatal clinic attendance (ANC).
Among the top 10 causes of death in Sierra Leone, approximately 60% are from infectious diseases with malaria, respiratory infections, diarrheal illnesses, tuberculosis, HIV/AIDS, and meningitis being the commonest. The country has experienced epidemics of deadly viruses locally in the last two decades. The Lassa virus in 2001, the Ebola virus epidemic in 2014, and outbreaks of the Zika virus have been reported. Non-communicable diseases contribute a less but significant proportion of the disease burden. However, the epidemiological transition with increased rural to urban migration, adoption of sedentary lifestyles, and improving socioeconomic statuses are likely to contribute to a larger proportion of the disease burden by 2050.
A cross-country comparison of Sierra Leone with other countries, high-income states such as the United States, reflects huge differences in most of the health indicators highlighted above. The Republic of Sierra Leone faces a considerable burden of communicable diseases, including epidemics such as Ebola. The country has also recorded among the world’s highest maternal mortality ratios; it has weaker health systems- an insufficient health workforce and inadequate health financing. Moreover, the country managed to attain political stability as late as 2002 after a decade of civil wars. Collectively environmental, political, and economic inferiority plays a significant role in the adverse health outcomes in Sierra Leone.
Response to COVID-19
COVID-19 continues to strain health systems worldwide, including countries with far superior systems such as the United States. The pandemic has not spared low-income countries such as Sierra Leone. Currently, 2153 cases and 73 deaths (3.3% case fatality rate) have been reported as of September 18th, 2020. Since the outbreak in China, the country was among the last African nations to report a COVID-19 case as late as April 2020. According to an article by Amy Maxmen, the lessons learned from the 2014 Ebola epidemics might have played a role in preparing the country’s health system response to the COVID-19 pandemic. However, the inherent weak health system has been exposed, resulting in a spike in the cases reported in the recent months with peaks in May and June 2020. The pandemic has exposed many health systems insisting on the need to strengthen health systems to prepare countries for current and future disease burdens.
Way Forward
Besides the need to strengthen the health system in Sierra Leone, the MoHS has partnered with the WHO as part of its cooperation plan to develop strategic goals 2017-2021 to improve the health status for the populations in Sierra Leone. The goals include:
- Improving maternal and child health
- Strengthening capacity for the public health system to respond to emergencies and health security.
- Reducing the impact of communicable disease and changing the trend with NCDs.
- Collective support towards strengthening the health systems.