6.1 Elements of Risk
The Lunsar area is faced with a number of problems that were created or aggravated by the war. There was heavy fighting in the area, and local men and youth were active on both sides. The reconciliation has not reached the level of mutual accept and respect as it was hoped for. There is still some tension and animosity between these individuals and between their
families.
The reintegration of ex-combatants, in particular the ex child soldiers, has not been a success. Because of poor organisation of that process a large number of young people have been immunised against reintegration and they represent a threat to the social stability of the area. There are other victims of the war. Among these are sexually abused girls and girl mothers, and people with various kind of physical and psychical handicaps caused by the war.
The percentage of children and youth who are not going to school is relatively high and so is consequently the level of illiteracy. However the feeling of shame seems to be stronger than the motivation to learn.
The unemployment is extremely high. Because of this and the looting and destruction of houses and tools for production, the poverty is knocking on most of the doors. The number of street children is increasing. These are not only the orphans, but some families are so poor that they cannot afford to give their children three meals a day. Some have lost the hope and they don’t care very much about their children.
There is still another group of marginalized children. There are many blind people in the area and some more are coming there for treatment at the eye hospital. Many of them are begging and they are using young children to guide them. These children do not go to school and the skill they are learning is begging.
The juvenile delinquency is increasing. Drug abuse, prostitution, theft and other kinds of unwanted behaviour are gaining space in the life of an increasing number of young people. The Lunsar area is at high risk for social unrest.
6.2 Assets
Lunsar area has much available and unused land, which represents a potential for reduction of unemployment and poverty in the area.
There are a number of both primary and secondary schools. The religious bodies organise activities for children and youth. Sport is recognised on all levels as a positive element in the community, and there is a number of youth and of strong women’s associations that are taking care of vulnerable groups and that are creating space for positive action in the community. We have certainly not met with all kinds of associations in the area, and there are NGOs both national and international represented.
6.3 Dividers and Connecters
We have not the impression that ethnic differences are important. People who fought against each other in the war are living together, but they still represent a kind of divider of
decreasing importance. We have not seen or heard of any sign of religious belonging as dividers. On the contrary, the religious bodies: the Muslims, the Catholics and the Baptists have created activities and/or institutions, in particular the schools, that are common fields for all categories of people, regardless of religious belongings. We rather see the religious
communities as interrelated connecters in the area.
The only divider we have noticed is political belonging. When the team wanted to meet with all organisations of the community youth, the city hall was closed for political reasons. The Baptist Church Ebenezer was considered as acceptable for all, and that church was used as meting place. Exactly the same thing happened when we wanted to meet all the community women’s associations. It was not possible to gather in a conference hall in town, but it was possible in the same Church of Ebenezer.
The strongest connecter seems to be sport. All groups seem to have a positive opinion of the role of sport in the community. It has a value in its own right. It is considered to be a powerful element of stabilisation of the area by all individuals and groups that we have interviewed, and it has a large potential for rapid growth if there is a positive input. Sport is also creating a forum where it is possible to engage a dialog concerning economic activities and the future for unemployed youth who are living at risk.
6.4 Target Group
We have described a local community that is at a high risk, with a number of negative aspects and some of these aspects are increasing in volume and strength. On the other hand we have been impressed by the way youth and women and religious communities have organised themselves in order to fight against these negative aspects and are trying to help the marginalized.
The target group will be pregnant women and children under five and their mothers. In particular the ones who are living in the rural areas outside the City of Lunsar, and those who for geographical or other reasons prefer to go to the Community Health Centre instead of to the catholic hospital.
6.5 Sustainability
At a number of occasions the people we talked with stressed and repeated the point that all projects should be sustainable. They had learned from experience with the NGOs that started activities, often rather good activities in their eyes that ended when the NGO considered that
their job was done, or that they did not have funds to carry through their activities. This experience had the positive effect that people insisted on sustainable profile.
This of course is clearly in line with the attitude of BUN. The objective for the project is to give training during two years, and the kits that will make it easier to do a good job. This will hopefully be a lasting improvement of the services. The other main objective is to teach groups of women about nutrition and how to bring this knowledge on to other women. This will also hopefully be lasting skills and knowledge. There are no plans for any new structure that will need funds or help from abroad.
6.6 Relevance
It is certain that some young women have joined groups that are already engaged in activities that are considered to be negative for the individuals and for the society. The are other women who have lost hope and don’t care any more, or they still want to, but life has been too
difficult. On the other hand, we have met women’s leaders who have organised activities, in some cases in a very strategic setting. Many of these realise that an improvement of the health situation for pregnant women and for children under five is within reach, but they need
training and guidance and some input on how they can be tools to reach other women with this new knowledge.
If it is possible to motivate women who are not having any regular income to go for
agriculture, it is highly relevant. There is a shortage of food in Sierra Leone, agriculture is a national priority, there is land available in Lunsar, and one youth association called“Young Investors” has identified agriculture as the activity in Lunsar that give the best benefit for their investments. It is also important to note that it is possible to produce locally the kind of food that is good nutrition for pregnant women and small children.
The approach is relevant because
- statistics show that the MMR and the IMR are extraordinary high in the Lunsar area. - it is strongly wanted by professionals and the women in Lunsar.
- the PRSP indicates that the Port Loko district has the highest contribution to poverty in Sierra Leone.
- It adresses the concern in pillar three in the PRSP: “Care will focus on maternal, infant and under-five mortality, malaria and communicable diseases, HIV/AIDS and other STDs. Devolution of health management will encourage community participation.” - the BCSL has adopted that paper as guideline for it’s own participation in the process. - it is line with the policy and experience of the BUN that states that a project should be
initiated locally, developed in cooperation, steered locally and get a profile that will eventually enable the local organisation to carry on with local resources if the project should continue.
- it is in line with the Norwegian Ministry of Foreign Affairs’ PRSP. The plan of action talks about a focus on tuberculosis, malaria, immunisation and reproductive health and a priority to target groups like children, youth and women. It also give priority to food security and a policy of strengthening the primary industries and that a good channel for this kind of cooperation is through Norwegian voluntary organisations (NGO) and institutions in cooperation with similar organisations in the developing countries.
6.7 Recommendations
First of all we will repeat that this is a feasibility study and not a project document. In line with a policy to be extremely open to input from the target group and also from resource persons and authorities, a detailed project will be presented as the missionaries have had enough time to be sure that the profile of the project reflects local priorities. This may also have consequences for the budget.
There should be a feasibility study of this kind for all new missionaries coming to serve in the work of the BCSL in order to strengthen the impact of their work.
The work of the missionaries should be sustainable after their departure and should not create new dependencies. Therefore the project should be low cost, with no input of cash, but be based on competence building and some material support.
The main objective for this project is to contribute to improve the situation for pregnant women and for children under five and their mothers.
The main effort of the project towards this goal should be to provide a resource person who could contribute by training and equipping mid-wives and related personnel and teach
women’s groups about nutrition and how they can bring this knowledge on to other women in a systematic way and to enhance the quality of the services the CHC is doing in this sector The details of this cooperation with the CHC and the women’s group will have to be elaborated when the missionary is present in Lunsar.
Officials in Freetown, in Port Loko and in Lunsar as well as the women’s groups in Lunsar have expressed the obvious need for training and refreshing Traditional Birth Assistants and for Maternal Child Health Aid, and that they get the necessary kits for their work. The missionary has expressed interest for training. We therefore recommend that part of her job will be to provide training and provide kits in the Lunsar area in close cooperation with the community health centre.
This centre needs rehabilitation. We therefore recommend that this rehabilitation should take place at an early a stage of the project.
The same health authorities have expressed the need for information about nutrition for pregnant women and for children 0-5 years and for sanitation. The women groups in Lunsar strongly expressed the same need and their willingness to do the sensitising if they got the training. We therefore recommend that the missionary should train the churchwomen and the community women to do this sensitising. This work should be based at the BC.
Two structures should be made for the project:
- A steering committee based in Lunsar with members from the Baptist Women’s Association,from the Community Health Centre and from the community. The moderator of the Baptist Convention should be a member.
- A combined advisory committee for the reproductive health project and the youth project, based in Freetown with a representative from the European Baptist Mission
(EBM), the coordinator of the social ministries, the coordinator of the church ministry and representatives from the Youth Union and from the Women’s Union. The General Secretary has a right in officio to be present in all committee meetings.
We recommend that because of the nature of this project, the majority of the members of the steering committee should be women. The advisory committee should try to have a equal number of members from each sex.
There are some good reasons to link the project to the Baptist Convention in Lunsar. It would facilitate the relations with the BUN because of the already existing routines for mutual information. The visit made it clear that when the meeting with the community women’s association was about to fail because of political reasons it was difficult to gather all
associations under the same roof, the Baptist Church building Ebenezer was accepted by all as an neutral place. Finally, the Baptist Women’s Association in Lunsar is rather big, and they have experience in running development activities.
7. BUDGET
A. Rehabilitation of Lunsar community health centre - rough estimate.
ITEMS QUANTITY UNIT COST TOTAL COST
Beds 5 300,000 1,500,000 Mattresses 5 80,000 400,000 Hard board 50 15,000 750,000 Cement 10 28,000 280,000 White wash 3 65,000 195,000 Paint (enamel) 40 32,000 1,280,000 Timber 55 12,000 660,000 Assorted nails 70pkts 1,500 105,000 Fillet 15bundles 12,000 180,000 Tables/cupboard 5sets 200,000 1,000,000 Doors 5 130,000 600,000 Locks 5 35,000 175,000
Mosquito wire net 5 roles 70,000 350,000
Windows 5 250,000 1,250,000
C.I sheets 6 bundles 200,000 1,200.000
Wash hand basin 1 150,000 150,000
Bed sheets 10 15,000 150,000
Pillows 5 12,000 60,000
Chairs 5 35,000 175,000
Estimate cost for the Community Health Centre Rehabilitation
LE 10,810,000 = 23.421,67 NOK = 23.500 NOK
Transport from Freetown to Lunsar by truck LE 3,000,000 = 6.500 NOK
Wages LE 4,000,000 = 8.666,82 = 8.700 NOK
Total 38.700 NOK
1 $ = 6.50 NOK B. Kits
These kits are used both for midwives and MCHAides. They are available in Sierra Leone at UNICEF’s Office
Midwifery drug kit, catalogue No 9902217 = 230,41$ = 1.497, 67 NOK= 1.500 NOK Midwifery equipment kit, catalogue No 9902218 = 168,99$ = 1.098,44 NOK = 1.100 NOK Midwifery supplementary kit, catalogue N0 9902224 = 14,52$ = 94,38 NOK = 95 NOK Total for one set of kits for Midwives and MCHAides 2.695 NOK A TBA kit can be prepared in Sierra Leone at the cost of 80$ = 520 NOK
13 sets of kits for midwives and MCNAides x 2.695 35.035 NOK 20 kits for Traditional Birth Attendants x 520 10.400 NOK
Total kits 45.435 NOK
Budget Summary
2007 2008 2009 Total Rehabilitation of Community Health Centre 38 700 38 700 Didactic equipment for training 5 000 1 000 1 000 7 000 Kits for midwives and MCNAides 35 035 35 035 Kits for Traditional Birth Attendants 10 400 10 400
Transport 15 000 15 000 10 000 40 000
Salary 120 000 160 000 110 000 390 000
Miscellaneous 8 000 9 000 6 000 23 000
Total 232 135 185 000 127 000 544 135
Comments to the budget:
- Most of the training will be practical, but it will probably be useful to purchase some didactic materiel
- There are 10 MCNAides, the centre and the missionary should have one set each, and there is one set extra, just in case it should be needed.
- There are 18 TBA + one set for the centre, and one set for the missionary
- She will have to travel a lot to visit the MCNAides and TBA where the live, but so far there is no policy for the use of the vehicle
- Salary: 50% of salary from January 2007 to June 2007. 100% salary Juli 2007 – September 2009
Appendix 1
SIERRA LEONE GOVERNMENT
MINISTRY OF HEALTH AND SANITATION
UPDATED INFORMATION SHEET – MAY 2005
Please note that in some cases the information is less accurate than would be desirable and caution is advised in the use of the data. The sources for the information are provided at the end of the document.
DEMOGRAPHIC AND OTHER GENERAL INDICATORS
ESTIMATES 2000/2 2005 ESTIMATES
Population3 6,372,698
Infant Mortality Rate 170/ 1,000 150/ 1,000
Under fives Mortality Rate/Ratio 1,800/100,000 Live Births 1,500/100,000 Live Births
Life expectancy at Birth 42 years 45 years
Average Completed Fertility 5,9 births/ woman 5,9 births/ woman
Disability Prevalence 7,0/ 1,000 7,0/ 1,000
Population per functioning hospital 162,000 39,829
Population per Doctor 17,333 54,000
Population per Professional Nurse 8,581 6,516
Population per Environmental Health Officer
25,366 52,235 Population per Peripheral Health Unit
(PHU) 12,470 7,936 Underweight Prevalence 27,2% 28% Stunting Prevalence 33,9% 40% Wasting Prevalence 9,8% 5% Prevalence of HIV/Aids 0,9% 3,4%
Access to Health Services 40% 60%
Access to Safe Water 54% 42,8%
Access to Sanitation 20% 29,6%
MORBIDITY (ILLNESSES)
Principal Causes of Morbidity (illnesses) in General population over 5 yrs 1. Malaria
2. ARI
3. Malnutrition
4. Onchoceriasis (River Blindness) and other Eye Conditions 5. Skin Diseasis
6. Leprosy/ Tuberculosis 7. Anaemia
8. Sexually Transmitted Infections 9. Hypertension
10. Psychosocial trauma
3
The population of Sierra Leone is now estimated between 6,000,000 and 7,000,000. For health planning we use an estimate of 6,732,698, based on the 1985 Census Figures and the Annual Growth Rate.
Principal Causes of Morbidity (illness) in the Under fives 1. Prematurity 2. Malaria 3. ARI 4. Infantile Diarrhoea 5. Malnutrition 6. Ophthalmic Neonatal 7. Worms 8. Skin diseases 9. Wounds 10. Measles
Most Important Epidemic Prone Diseases 1. Cholera
2. Measles (UNDERFIVES) 3. Meningitis
4. Lassa fever 5. HIV/AIDS
NUMBER AND DISTRIBUTION OF FUNCTIONING HOSPITALS AND PERIPHERAL HEALTH UNITS
20 02 2004 /5
HOSPITALS PHUS HOSPITALS PHUS
Sierra Leone 32 372 59 803 Eastern Province 3 67 12 210 Kailahun 0 5 4 576 Kenema 3 52 6 91 Kono 0 10 2 62 Northern Province 5 121 14 298 Bombali 1 6 3 66 Kambia 0 20 2 36 Koinadugu 1 15 1 52 Port Loko 3 40 5 75 Tonkolili 0 40 3 69 Southern Province 5 149 10 258 Bo 1 50 3 82 Bonthe 2 18 3 34 Moyamba 1 51 3 95 Pujehun 1 30 1 47 Western Area 19 35 23 37
HEALTH SERVICE UTILIZATION RATES
EST 2002
EST 2004 Percentage of Births attended by trained health personnel 41,7% 43,0% Percentage of women (15-49) who attended Antenatal Clinic at least once 68,9% 65% Percentage of women using modern contraceptive methods 3,9% 5,0%
DPT immunisation coverage (12-23 months) 55,5% 59%
Measles immunisation coverage (12-23 months) 51,7% 53%
Polio immunisation coverage 61,2% 60%
Percentage of under fives children with Malria treated with anti malarial drugs
60,9% 65%
HUMAN RESOURCES (KEY PERSONNEL)
ESTIMATES 2002 ESTIMATES 2004/5
Doctors 300 118
Professional Nurses & Mid/wives 606 1062
Environmental Health Officers 204 122
Community Health Officers 284 132
Lab Technicians 40 46 Lab Technologists 7 6 Pharmacists 12 13 Dispensers/Druggists 110 117 Radiographers 12 8 Nutritionists 12 4
Number of NGOs Active in the Health Sector 123
Sources:
The above information was compiled from various sources including:
Ministry of Health and Sanitation Planning and Information Office data Multi-Indicator Cluster Survey 2