Safer Deliveries in Sierra Leone

Data from the World Health Organization show that Sierra Leone has the highest rate of maternal mortality of any country in the world, with 2,100 maternal deaths per 100,000 live births (compared, for example, with 11 in the US and 7 in Canada). The New York Times reports on a new internationally-funded program in Sierra Leone to waive fees for pregnancy and delivery in order to improve birth outcomes.

Sierra Leone is at the vanguard of a revolution — heavily subsidized for now by international donors — that appears to be substantially lessening health dangers here in one of the riskiest countries in the world for pregnant women and small children.

Country after country in sub-Saharan Africa has waived medical fees in recent years, particularly for women and children, and while experts acknowledge that many more people are getting care, they caution that it is still too early to declare that the efforts have measurably improved health on the continent.

In Sierra Leone, though, it seems clear that lives are being saved, providing an early and concrete lesson about the impact of making health care free for the very poor and vulnerable.

By waiving the requirement for payments — which sometimes amount to hundreds of dollars and clearly represent the main barrier to using health facilities — the government here appears to have sharply cut into mortality rates for pregnant women and deaths from malaria for small children.

The results in Sierra Leone have been “nothing short of spectacular,” said Robert Yates, a senior health economist in Britain’s Department for International Development, which is paying for almost 40 percent of the $35 million program, with most of the rest coming from donors like the World Bank. Since waiving the fees, Sierra Leone has seen a 214 percent increase in the number of children under 5 getting care at health facilities, a 61 percent decrease in mortality rates in difficult pregnancy cases at health clinics, and an 85 percent drop in the malaria fatality rate for children treated in hospitals, according to figures Mr. Yates supplied.

International donor agencies are unlikely to fund this program forever, so the hope is that with better health will come greater economic productivity (the country has diamond and other mineral resources), political stability and eventually the ability to pay for programs like this from the country's own pockets.