Description of emergency, health impact and WHO’s position

At the beginning of May 2000, the situation of peace that had been achieved between rebel factions and pro-government forces, the situation in Sierra Leone took a dramatic new turn with RUF and the re-armed SLA/AFRC fighting again between them. At the time that this report is prepared about 500 UN peacekeepers are kept prisoners by the RUF and the overall situation in the entire country is extremely unstable with ongoing attacks in Waterloo and Port Loko. About 20,000 Internally Displaced People have moved from Waterloo area to Freetown and many thousands have crossed the border to Guinea.

On 7 July 1999, the Accord signed in Lomé provided a framework for the resolution of hostilities. A Cease-fire has been observed for one year and a Government of National Unity had been formed. At the time that hostilities restarted, a UN peacekeeping force was reaching the completion of full deployment. Disarmament and demobilisation had continued to make slow progress. In some parts of the country, especially in the North, humanitarian access remained hindered, with rebel groups continuing to engage in human rights violations.

WHO’s support to Sierra Leone includes a significant relief and rehabilitation component, the latter aiming at recovering the war-damaged health facilities and services and care for displaced populations. All WHO programmes in Sierra Leone prioritise attention to vulnerable groups, including internally displaced people, and in this sense all country activities have an emergency focus. WHO works especially with NGOs on innovative projects which show promise for national adaptation.

WHO’s activities will focus on relief and /or rehabilitation programmes according to the development of the political and humanitarian situation in Sierra Leone. Because WHO is not a donor or field-operational agency, it will not have a role in delivery of massive quantities of material aid into newly accessible areas. However, WHO has been involved in the development of district health systems in all of the districts of Sierra Leone, and WHO professional officers are intimately familiar with health conditions and health services throughout the country.
 
 

Achievements and Constraints

WHO’s main contributions are focusing on:

• Health situation assessments (disease burden, logistics planning, manpower and facility planning)
• Support to surveillance and control of specific disease problems (cholera, Lassa fever, meningitis, malaria, HIV/AIDS, other epidemic-prone diseases)
• Polio eradication (including acute flaccid paralysis surveillance) in difficult/inaccessible areas, as part of the national eradication programme,
• Re-establishment of District Health Management Teams (DHMTs) under District Medical Officers (this is the mechanism for transition from relief work to sustainable long-term programmes)
• Focussed delivery of emergency drugs and supplies to points of critical need
• Execution role, when requested, with MoH for key activities, such as HIV/AIDS control

• improve reproductive health and reduce maternal mortality
• eradicate poliomyelitis; control communicable diseases
• control malaria
• control HIV/AIDS and STDs
• monitor and analyse emergency health situation; develop structured and systematic reporting system
• improve district health systems; advise on reorganisation and reform of health sector, including financing and cost recovery

WHO Staff presence and/or Security Constraints

In addition to the WHO Country Representative, whose professional background is in clinical and academic medicine and child survival programming, the WHO Sierra Leone Country Office has seven professional staff, all but one of whom are Sierra Leone national officers:

A Disease Prevention and Control medical officer is responsible for surveillance and control of communicable diseases including vaccine-preventable diseases, HIV/AIDS/STDs and cholera. He designs and implements training for case management and epidemic control, co-ordinates support to district health systems including management training, supervises clinical aspects of disease eradication and elimination programmes including training for AFP surveillance (polio eradication) and co-ordinates activities for maternal mortality reduction.

A newly recruited expatriate Public Health Specialist is responsible for development of new tools and systems for monitoring and reporting on the health situation, integrating information from all sources including government and NGOs. He is supported by two sub-office co-ordinators. The sub-office co-ordinators supervise activities at WHO sub-offices in Bo with a second sub-office to be opened in Makeni. They also participate in special studies including disease outbreak investigations.
 
 

A Health Economist advises MoH on health systems reform and financing, which are particularly difficult policy issues in this country. He also assists in programme and financial management for polio eradication as well as overall WHO programme management. A Human Resources Specialist manages external (fellowship) training and is also responsible for environmental programming including water and sanitation programmes. A Health Information Officer adapts global WHO health information for use in Sierra Leone and assists local journalists in preparation and dissemination of health-related information in print and electronic media.
 
 

Regular Budget

In order to show the programmes implemented by WHO in Sierra Leone in the biennium 98-99, the regular budget referring to that period is below reported.
 

	Sierra Leone - Regular Budget 98-99
	Source: AFRO Regional Committee 46th Session
	Brazzaville, September 1996.
	Budget Line	USD
	National Health Policies Management	720,000
	PHC - Health System Management	225,000
	Human Resources (Training)	250,000
	Reproductive Health	220,000
	Control of Other Comm. Diseases	199,000
	Essential Drugs	100,000
	TOTAL	1,714,000

 

Summary/WHO component of UNCAP and funds mobilised

In the current UN Agency Consolidated Appeal, WHO has identified several key problems for which current support is insufficient. These are mental health, malaria control, disease surveillance and control, physical rehabilitation, safe blood transfusion services and rehabilitation of District Hospitals. Of these, mental health is receiving some attention from NGOs, but for the most part this is in the form of small-scale local projects. There is an urgent need for support to national mental health programmes, including rehabilitation of the national referral hospital and development of community psychiatry services. For malaria control, support from global Roll Back Malaria (RBM) partners is anticipated, but not yet confirmed. Disease surveillance and control has been supported through WHO Regular Budget, but additional inputs will be needed to re-establish functional systems in previously rebel-held areas. For physical rehabilitation services including prosthetics, fragmented support is available from several NGOs. Safe blood transfusion services are being addressed in Freetown and Lungi, using WHO RB funds in Cupertino with the Red Cross Society of Sierra Leone and in Bo by MSF/Belgium, but there are emerging needs for the remainder of the country which will require additional funding. For District Hospitals, there is an urgent need to restore services in facilities devastated by the nine-year civil conflict. This will ensure that critically ill patients referred from peripheral health units (PHUs- now being re-established with support MoH and multiple partners) will be adequately cared for. In the absence of inputs at this level, ongoing support to the PHUs will not yield the expected benefits in mortality reduction. All of these problems will be serious in newly accessible areas, and should be addressed as part of the short- and long-term humanitarian response.

Following, the components and budget for which WHO sough a contributions in the 2000 CAP:

1. Control of Malaria Programme 119,780

2. Mental Health 265,860

3. Emergency District Hospital Rehabilitation Programme 446,350

4. Provision of Safe Blood Services 265,550

5. Epidemiological Surveillance, Prevention and Control of

Communicable Diseases and Epidemics 232,780

6. Assistance to Amputees 378,550

TOTAL 1708,887
 
 

Up to date, no information re any pledge to the 2000 CAP WHO for Sierra Leone has been received by WHO.