In reading Donnelly’s account of Sierra Leone’s efforts to prioritize maternal health by providing free care to pregnant women, breastfeeding mothers, and children under the age of five, I was impressed by the attempt to improve access to health care. The swift creation of this health delivery system demonstrated President Koroma’s influence in leading these efforts, but also the importance of a country’s leadership in bringing various aid and development groups together to work on a single problem. Sierra Leone is an interesting example of a state bringing organizations together to focus on a single issue that directly affects the country’s health system, opposed to aid organizations arriving in a country to address a specific disease or threat without the health structure being in place. Given that after only one year of implementation, the story is already being declared a success, it is important to consider the remaining threats to maternal health access that still exist in Sierra Leone and may be consistent in other countries with similar barriers.
Practitioners and administrators must always be cautious in regards to cultural differences that impact healthcare. In Sierra Leone, a country that includes four different provinces and sixteen tribes, being aware of local beliefs is essential when addressing health concerns. Chinedu Offor examined some of the potential issues with an emphasis on the power discrepancy between men and women. Some barriers include the need for one’s husband’s approval before seeking medical care, women having little say in regards to family planning, and dietary differentials, amongst others. The Sierra Leone project largely addresses the first issue by removing cost barriers that might prevent a man from encouraging healthcare for his wife. Regarding family planning, Offor outlines cultural issues such as the desire to have many children in anticipation of few surviving to adulthood. For a country that ranked number 180 out of 182 in the 2007 United Nations Human Development Index, expanding health care will hopefully have a long-term effect of improving life expectancy rates. This increase could eventually remove the need to have a large family to ensure survival. I found the dietary restrictions to be particularly interesting in that women are sometimes urged to offer protein sources to the husband as a sign of affection. While all of these issues require program administrators to work closely with local leadership, the diet issue appears to be one that could be overcome through better communication of maternal health. Globally, if Sierra Leone is going to be used as a model for implementation elsewhere, it is important that leaders remember that cost is only one of a variety of barriers that prevent women from getting the care that they need.
While close communication between local leadership and program leaders is critical in continuing to build on Sierra Leone’s maternal health success, the Department for International Development has also shown the introduction of mobile phones to be helpful technology in increasing communication between health centers. This ensures that providers can share knowledge about specific cases, but also discuss logistics, and move patients as needed. There is the hope that mobile phones will enhance communication between providers and clients, which could be significant in helping women to overcome some of the cultural barriers that some may experience. With a mobile phone, women would be free to contact providers with questions about contraception and pregnancy testing, while also providing a critical outlet for emergency circumstances. This is just one example of the promising health implications for Sierra Leone as mobile phones become more popular.