Making health services available to the most remote communities in Kenema and Kailahun



By Ahmed Sahid Nasralla (De Monk)



Interior of a PHU in Nyemeya in Tunkia chiefdom, Kenema District          



A group of NGO field workers recently visited communities in remote chiefdoms – such as in the Gola Forest catchment areas in Kenema district in Eastern Sierra Leone, defying all the odds to reach a remote set of people who seem to have been neglected for ages.

Some of the communities are practically inaccessible; yet the field workers braved it, walking long and rugged distances and crossing rivers on rickety canoe boats under rain and shine.

They found that the rough terrain is a big obstacle preventing these communities from benefiting from development projects, including essential services like clean drinking water, energy supply and health services. The majority of lactating mothers, pregnant women and children under five in these communities do not benefit from most immunizations and other campaigns from the Ministry of Health and Sanitation and other development partners.

The health centers in these remote rural communities are virtually non-functional, if not dilapidated; lacking staff and equipment, and with no means of transporting emergency cases to the Kenema Government Hospital.

The field workers were from a NGO called SEND Sierra Leone and their mission was to prepare the communities for the coming of a needs-assessment team. With funding from the German Federal Ministry of Economic Cooperation and Development and the international NGO Welthungerhilfe (WHH), SEND Sierra Leone in partnership with another organization called ENFO (Energy for Opportunity) will work in both Kailahun and Kenema districts to improve health in the selected target areas through infrastructural rehabilitation of PHUs, as well as awareness-raising measures in the areas of health, hygiene and nutrition in the catchment population. The project will target 20 public health facilities to contribute to a robust health system capable of preventing future epidemics and delivering better and safer health services to rural populations.

“Making health services accessible to these communities is crucial,” said SEND Field Staff, Peter Mboyawa. “We are responsible for awareness-raising and training of the catchment communities and health personnel, while ENFO will take care of rehabilitation, renovation and installation of WASH facilities and solar power in all 20 health centers.”

According to the District Medical Officer (DMO) in Kenema, Dr. Mohamed Vandi, the health centers supported by the project were selected through consultation with the DHMT and the Kenema District Council and preference was given to PHUs that needed support the most – in rural areas where the number of functioning PHUs is low and where people have to travel far distances to access health care.

“It is unprecedented that within one year 10 health centers are going to be rehabilitated in the district,” he said proudly, adding that they will monitor the implementation of the project stage by stage and they will not leave it entirely to SEND Sierra Leone and ENFO.

To further prepare the targeted communities SEND Sierra Leone organized a one-day workshop on 9th August at the Kenema District Council Hall, Kenema town, with key community stakeholders to discuss the project and its approach. Participants were selected ten each from five targeted chiefdoms- Nomo, Gorama Mende, Koya, Wandor and Tunkia chiefdoms. The participants included Paramount Chiefs, Mammy Queens, women leaders, youth leaders, religious leaders, teachers and health workers, among others.

The workshop discussed key topics to address during awareness-raising exercises including hygiene and health, nutrition and relationship between the population and the health system. The participants further suggested ways to involve community stakeholders for better impact. Issues of accountability, building trust, coordination, monitoring and training in relation to the project implementation were also discussed. The participants also made recommendations to help SEND Sierra Leone and ENFO implement the project well.

“The project can only be successful if everybody is involved and understand the project and responsibilities,” said Partner Adviser of WHH, Valerie van Zutphen, adding that the project is in line with the government’s post-Ebola recovery program for the health sector in rural communities.

According to the Chairman of the Kenema District Council, Dr. Senessie Mansaray, most development projects have succeeded or failed depending on what happens at the initial stage.

“Many water well projects in our communities have been unsuccessful because the implementing organisations failed to include the people from the onset,” he noted, and commended SEND Sierra Leone and ENFO for involving the communities from the start in the design and implementation of the project. People from the local community will also be trained to maintenance the facilities.

Without running water no health center will function, noted the District Supervisor for the Ministry of Water Resources attached to the district council, Kai Unisa. He therefore encouraged SEND Sierra Leone and ENFO to go through the engineer in the office of the Ministry of Water Resources in the district to advise in that regard, as they have a laboratory to test the quality of the water supply.

The project, Improvement of Health Care Through Infrastructure and Capacity Building Measures, is expected to be completed within three years from 2016 – 2018.