Analytical summary - Health information, research, evidence and knowledge
There has been some progress on the health information management system. Reporting completeness has increased from 74% in 2009 to 83% in 2010. However, the good progress of the implementation and strengthening of the health management information system has been weakened by the non-existence of a functional interoperable human resources for health, health financial management and health logistics management information systems. Furthermore, the use of information for decision-making has not been widespread within the sector.
The health status of the people of Sierra Leone is still among the poorest indicators in the world. Infant and maternal mortality rates remain among the highest in the world. According to the Sierra Leone demographic health survey 2008, life expectancy is 47 years, infant mortality rate is 89 per 1000 live births, under-five mortality rate is 140 per 1000 live births and the maternal mortality ratio is 857 per 100 000 births.
Fertility rates are high due to low contraceptive prevalence rates. Women in Sierra Leone bear on average 5.1 children: 3.8 in urban areas and 5.8 in rural areas. The lowest birth rate is 3.4 in the Western Region and the highest is 5.8 in the Northern Region. The fertility rates vary according to maternal education and economic status. Women who have the highest education levels bear on average 3.1 children, while women with no education bear almost twice as many children.
Similarly, fertility increases as the wealth of households decreases. The poorest women bear twice as many children as women who live in the wealthiest households: 6.3 versus 3.2 children per woman.
The majority of the causes of illness and death, especially of children, in Sierra Leone are preventable, with most deaths attributable to nutritional deficiencies, pneumonia, diarrhoeal diseases, anaemia, malaria, tuberculosis and HIV/AIDS. Malaria (38%), acute respiratory infection (16.9%) and watery and bloody diarrhoea (9.7%) are the major causes of outpatient attendance and illness.
The underlying factors for the high burden of disease are:
- pervasive poverty
- high level of illiteracy, especially among females
- limited access to safe drinking water and adequate sanitation
- poor feeding and hygienic practices
- overcrowded housing
- limited access to quality health services.
According to the trends in both infant and under-five mortality rate since 1990, an infant mortality rate of 50 per 1000 live births and an under-five mortality rate of 95 per 1000 live births are projected for 2015, in line with the expected target for Millennium Development Goal 4 in Sierra Leone. Given the prevailing determination of the Government of Sierra Leone and the huge support of development partners to reduce child mortality, perhaps with scaling-up of child health interventions and sustained efforts to address health system bottlenecks, Sierra Leone is likely to meet the Millennium Development Goal 4 goal.
The extremely high incidence of mumps, measles and rubella in Sierra Leone in 2000 and the preceding years may be partly due to the civil conflict, which made it practically impossible to deliver any health care service. Other factors include:
- user fees
- inadequate number of comprehensive and basic emergency obstetric and neonatal care facilities
- long travel times to health centres given poor road conditions
- women’s poor nutrition and care before and during pregnancy
- poorly trained and motivated staff
- lack of equipment, supplies and staff.
A recent health sector performance assessment highlighted the following issues:
- District Health Information Software 2 (DHIS 2) was used to collect, collate and analyse data in 2010;
- capacities were improved at national and district levels, data collection and reporting tools harmonized, data collection at community levels strengthened and quarterly and annual statistics reports produced;
- updating the health information system strategic plan and tools for its implementation with partner participation, and mobilizing the required resources were continuing;
- there was no steering committee for the health information system;
- there was late reporting by some peripheral health units and district health management teams;
- computers used for the district health information system were not protected from viruses in some districts;
- there were no dedicated staff to collect data at health facilities (e.g. matrons and hospital administrators collected data haphazardly in hospitals);
- there were no health information system committees;
- there were inadequate registers at hospitals;
- among the four National Health Sector Strategic Plan strategic objectives for health information, 24 targets were planned for implementation in 2010; six targets were fully achieved, 10 were partially achieved and eight were not achieved;
- delays were experienced in achieving targets for appropriate use of data and information, comprehensive monitoring and evaluation plan, and improving other data sources such as population-based surveys.