Increasing the provision of essential health care services through support of health workers in Sierra Leone

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DFID committed 12 million GBP to uplift frontline health workers’ salaries in Sierra Leone from 2010 to 2015 to support the implementation of the Free Healthcare Initiative (FHCI), launched in April 2010, which made health services free for pregnant women, children under five years of age and nursing mothers. Increasing the availability of frontline health workers to deliver services, by uplifting their salaries and introducing a sanction framework was hoped to discourage the application of user fees for services to mothers and children and support the aims of the FHCI. It was estimated that over the implementation period 1.1 million pregnant women and lactating mothers, and 5 million children under the age of five could benefit, with a total of 141,000 lives saved.

DFID funding was allocated as budget support to the Government of Sierra Leone (GoSL), with disbursements released based on progress made against agreed milestones that were monitored by a joint donor Government Payroll Steering Committee (PSC). Over the lifetime of the project underperformance against some of the milestones led to 600,000 GBP of the funding not being disbursed.

The project was delivered through three outputs, aimed at increasing the uptake of health care by the most vulnerable. These included: (1) the efficient management of the payroll, (2) enhanced capacity of the Ministry of Health & Sanitation (MoHS) to manage the attendance and deployment of human resources for health (HRH), and (3) effective community oversight of the FHCI.

Overall, the project has scored an A as it has met expectations. The salary uplift has helped to attract, retain, and motivate health workers in the public health sector and to reduce absenteeism and moonlighting, despite increasingly heavy workloads as a result of the removal of user fees. The salary uplift has also attracted health workers back from the private sector.

The holding of PSC committee meetings and the frequency of monitoring visits to the districts decreased in the last year due to travel restrictions that were put in place because of the Ebola outbreak. This has meant that there is limited data to judge performance against the 2015 milestones. However key informants have reported that the support provided to salaries through this project, and the availability of motivated frontline workers contributed to the resilience of the health workforce during the Ebola outbreak and enhanced the GoSL’s response to it.

This project completion report provides details of programme performance, output scoring, and value for money and financial performance. It also provides a set of recommendations for the GoSL (particularly the MoSH) and DFID and other development partners.

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