1. The Free Health Care Policy Presentation to the Supply Division By Mr. MahimboMdoe UNICEF Sierra Leone

3. The Free Health Care Policy

4. Post launch achievements

5. Towards sustainability: short and long term planning

6. Financing

7. Critical NeedsUNICEF

8. UNICEF

10. 70% of population lives with less than a dollar a day

11. Human Development Index 2009: 180/182.

12. Infant, under five and maternal mortality rates amongst the highest in the world:

13. One in five children do not see their fifth birthday

14. One in eight mothers risk dying during childbirth

15. Malaria, diarrhoea, measles and respiratory infections major causes for child deaths

16. Access to health services severely limitedUNICEF

18. FHC was successfully launched on April 27th after 6 months of intensive work.

19. Process was led by a steering committee and supported by 6 subcommittees – HR, M&E, Logistics and Supply, Infrastructure, Finance, Communication - all chaired by MoHS.

20. UNICEF has been actively involved throughout the preparation period as co-chair of the Logistic and Supplies sub-committee and a member of all other committees.UNICEF

22. The health sector has undergone a number of reforms during the last 6 months, e.g. payroll cleaning, revised salaries, recruitment.

23. Committees are continuing their work to ensure successful delivery of FHC.

24. Strategy to be developed for both short and long term management in order to ensure sustainability.UNICEF

25. Impact – after an unexpected decrease in utilization prior to launch here has been asignificant increase in utilization of health facilities The M&E subcommittee has formed a taskforce to strengthening the existing health management information system. Recently completed a baseline review of FHC with support from WHO and participation from all districts with objective to review health sector performance against key sector indicators and setting baselines and targets for the FHC. A national level review is planned for August. It is working with CSOs to strengthened community ownership and monitoring of health services through the revitalisations of health management committees at community level and is working to improve supervision.

26. UNICEF

27. Impact – in spite of increase in utilization the lack of drugs and delays in patients presenting themselves means there has been a increase in fatality rates An immediate investigation has been carried out to find the determining causes which include lack of paediatric drugs available and the number of patients which are admitted late and die within a short timeframe of being admitted. Work will be done through health education to ensure population sensitized and aware to come to the health facility as soon as symptoms present themselves

29. Payrollreformsimplemented to ensurelegitimatehealthworkerspaidappropriately.

30. Health workersreceived a substantialincrease in salaries  attractsstaff, ensuresfeesarenotbeingcharged.

31. Challenges: payment transfer, accommodation for new staff, shortfall of staffUNICEF

33. 88 % of the received drugs and medical supplies have been distributed to the districts and the PHUs, while a balance of 12% buffer is kept at the Central Medical Stores (CMS) to meet the call forwards needs from the districts and PHUs.

34. Additional 30% of FHC-I drugs in 20 containers and 3 packages have been received and are awaiting clearance at the ports after which they will be distributed.UNICEF

36. UNICEF in addition to clearing the supplies is also providing transport for the distribution of supplies from the CMS to the Districts.

37. UNICEF is providing ongoing support to the CMS on effective warehouse management and LMIS operations.UNICEF

40. Second phase: implementation, capacity building and handing over to MoHS (phase out) expected to commence soon.

41. High level steering committee (oversight).UNICEF

43. Fuel costs, operating cost for maintenance of vehicles planned routes, mileage, days, drivers salaries

44. Inventory Control System, warehouse racking and shelving

45. Timely release of funds for completion and refurbishments of DMS.

47. In process to support 112 PHUs and 7 district hospitals with pipe borne water and sanitation facilities. In addition, the 65 BEmONCcentres will also get pipe born water facilities by the end of the year.

48. Planning to support rehabilitation of pediatric wards in 7 district hospitals and strengthening of BEmONC services in 65 PHUs. UNICEF

50. Procurement of equipment is underway.

51. Process designed to identify problems, allocate responsibilities and track progress.

52. Funds available for further refurbishment of hospitals from Arab donors.

53. District level responsibility and accountability. UNICEF

55. Supported development of FHC-I baseline and monitoring indicators in collaboration with WHO, MoHS and District Health Management Teams (DHMTs).

56. Supporting Health for All Coalition in the monitoring of FHC-I at facility level nationwide.UNICEF

58. UNICEF will participate in the quarterly review of progress on FHC monitoring indicators, in collaboration with MOHS, other UN agencies (WHO, UNFPA) and DHMTs.

59. Major challenges: development of system to capture data still on going

60. Urgent need for baseline data to prove performance and thereby ensure future fundsUNICEF

62. Supported engagement with health workers and health workforce associations to allay their fears, communicate the policy and clarify doubts and misconceptions.

63. Supported planning and implementation of National and District level launch on April 27, 2010.UNICEF

65. Supporting 5-6 CSOs for community level awareness on FHC-I, to compliment MoHS communication activities at the sub-national level.UNICEF

67. Realignment of somedonorfunding to meetfinancinggaps.

68. Costing of activitiesrequired for the remainder of 2010 ($1.3m available, $4.4m costsresulting in a gap of $3.1m).

69. Forecasting of salaryscenarios –detailedbudgeting and forecasting of salaryscenarios to providetechnicalbackup to salaryreform for healthtechnicalworkers. UNICEF

72. Governance, accountability and continued commitment (leadership and funds)

73. Capacity building, quality of services

74. Monitoring, including LMIS

75. CSO involvement

76. Demand generationUNICEF

78. Governance, leadership, accountability, contd .commitment

79. Capacity building, quality of services

80. Monitoring (incl. LMIS)

81. CSO involvement

82. Demand generationDfiD World Bank UNICEF Govt. HDP + Dr. Daoh (HDP meeting) Year 2 Plan for FHC/RCH

84. Overall management: DPI/MoHS under the direction of the CMO.

85. Gov. led process to do costing, implementing plan and resource coordination.

86. TA needed to strengthen Finance, M&E, HR and PSM.UNICEF

88. Governance, leadership, accountability, contd .commitment

89. Capacity building, quality of services

90. Monitoring (incl. LMIS)

91. CSO involvement

93. TORs for Compact

94. TAHDP + Dr. Daoh Year 2 Plan for FHC/RCH (aim for Sept 2010)

95. Funding UNICEF

97. Sustained leadership – Health Minister

98. Payroll integrity

99. Reliable monitoring

100. Controlling losses

101. Political momentum

102. IHP+ compact

103. PSMUNICEF

104. Thank you!