Research for stronger health systems during and after crisis

Sierra Leone's Free Health Care Initiative - Evaluation report published

Saturday, 21 May 2016

ReBUILD’s Sophie Witter has just led an evaluation of Sierra Leone’s Free Health Care Initiative.

Sierra Leone Free Health Care Initiative (FHCI): process and effectiveness review (2016) by Sophie Witter, Nouria Brikci, Tim Harris, Richard Williams, Sarah Keen, Ana Mujica, Alex Jones, Alex Murray-Zmijewski, Barbara Bale, Bailah Leigh and Ade Renner

Launched in April 2010, the Free Health Care Initiative (FHCI) took an ambitious approach to reducing financial barriers by introducing health systems strengthening across all pillars (Governance, Communications, M&E, Drugs and Medical Supplies, Infrastructure, Health Workforce, and Financing). The review conducted in 2014-16 used a theory-based evaluation approach with mixed methods.

In the evaluation report, the authors conclude that the FHCI responded to a clear need in Sierra Leone, was well designed to bring about needed changes in the health system to deliver services to the target beneficiaries (under-fives, pregnant women and lactating mothers), and brought funds and momentum to produce important systemic reforms. Strong and sustained political will, with donor cooperation and support, together with consensus that the FHCI was significant and worth supporting, were also crucial, although weaknesses in implementation have been evident in some core areas.

It is less clear whether the FHCI contribution fed through into improved health, although there was a sharp drop in under-five mortality associated with the start of the initiative, with modelled cost-effectiveness high (around US$ 420 - US$ 444 per life year saved).

The authors stress the importance of efforts to monitor and improve the quality of care provided in public facilities, and for efforts to overcome transport and other barriers to ensure fair distribution of gains. Improving the economy and efficiency of key resources will also be critical, together with strengthening the MoHS and district level health functions. Sustainability of the FHCI also needs increased public investment in health care in general, and enhanced performance and accountability of all stakeholders including development partners.

Comparing Sierra Leone’s FHCI experiences with similar policies adopted in other African countries, both neighbours and other post-conflict settings, provides some insights for Sierra Leone as it considers future financing options. And there are lessons for other countries implementing free health initiatives.

The report can be accessed here: Sierra Leone Free Health Care Initiative (FHCI): process and effectiveness review (2016) bySophie Witter, Nouria Brikci, Tim Harris, Richard Williams, Sarah Keen, Ana Mujica, Alex Jones, Alex Murray-Zmijewski, Barbara Bale, Bailah Leigh and Ade Renner.

And a summary presentation can be viewed here:

Photo credit: Robert Yates / Department for International Development