Analytical summary - Health financing system
Consequently, funding is requested from the consolidated fund and development partners. The health sector is substantially dependent on external resources for funding. The estimated cost to implement the Free Health Care Initiative policy in 2010 was US$ 35 840 173, of which 86.5% was provided by partners, mainly the Asian Development Bank, Department for International Development (United Kingdom), United Nations Children’s Fund, United Nations Population Fund and World Bank (see tables).
The main attempt to pool out-of-pocket payments has been through community loan funds. There are now a variety of these schemes operated by communities, sometimes with assistance from nongovernment agencies. During the early 1990s, loan schemes were developed in Bo District to help households cover the cost of transport and care while in hospital for emergency obstetric care. These were financed from per capita contributions in six chiefdoms, as part of the Prevention of Maternal Mortality Initiative in collaboration with Colombia University.
Currently, the major mechanism for pooling funds is provided through collaboration between the Government of Sierra Leone and development partners, as expressed by the Joint Programme of Work and Funding.
Both Government and donor expenditure on health has continued to decline and in 2007 Government expenditure was only 22% of the total, with the remainder (78%) being external funding (see tables). The percentage of Government expenditure on health as a percentage of the total continued to be around 8%.
The 2010 performance report reveals that more funds were disbursed for recurrent expenditure in 2010, although in the same proportions as in 2009. In fact, the health expenditure in 2010 was more than twice that of 2009 (see tables). The report also shows that there was a remarkable increase in staff salary in preparation for the introduction of the Free Health Care Initiative.
In 2011, the Ministry of Health and Sanitation received 8.2% of the total Government budget. Thus, the health sector has been grossly underfunded in the past and has never reached the Abuja Declaration target of 15% of total government allocation.
This is why the Ministry has put strategies in place to justify the need for the Government to honour the Abuja Declaration and to provide evidence to justify an increase in resource allocation, especially for reproductive, newborn and child health care, both in support of the Free Health Care Initiative and for the achievement of the health-related Millennium Development Goals.
There are two main systems of payment for health care services: cost recovery and service user charges. The Ministry does not currently issue countrywide fee guidance. Instead, districts are encouraged to set fees with the involvement of local communities by consulting with village development committees and city and district councils. Health care in Sierra Leone is principally financed from private, out-of-pocket payments (69%). This is mainly made up of spending on medicines. In addition to the target groups covered by the Free Health Care Initiative policy, some other exempt groups from the cost recovery system include emergencies, the destitute, and those with tuberculosis, HIV and other priority diseases.
However, while there are funds to support the Free Health Care Initiative, there is no readily available funding for the other exempt groups. If the charges for these groups are thus waived this undermines the cost recovery system, which should ensure that some revenue can be retained by facilities. There is then a trade-off between ensuring local cash flow and meeting the commitment to provide medicines at minimal cost to those in need.
Insurance is at an early stage throughout the country. The Ministry of Health and Sanitation, in collaboration with the National Social Security and Insurance Trust and the International Labour Organization, is exploring the possibility of establishing and implementing a national health insurance in Sierra Leone.
The recent health sector performance assessment highlighted, among other things, that salaries of health workers have been restructured and that the financial management capacity at district health management team and hospital levels is weak, resulting in delays in liquidation of funds.
- ↑ 1.0 1.1 National Health Sector Strategic Plan 2010–2015 (pdf 1.09Mb). Government of Sierra Leone, Ministry of Health and Sanitation, 2009
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Leigh B. Child survival and development mid-term review report for the programme 2008–2010. Sierra Leone, United Nations Children’s Fund, 2009
- ↑ 3.0 3.1 Free health care initiative report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010
- ↑ 4.0 4.1 Gibril A et al. Sierra Leone health sector review, 2004
- ↑ 5.0 5.1 National Health Sector Strategic Plan 2010–2015 Joint Programme of Work and Funding (JPWF) 2012–2014 (pdf 2.79Mb). Government of Sierra Leone, Ministry of Health and Sanitation, 2012
- ↑ 6.0 6.1 6.2 6.3 Review of financing of health in Sierra Leone and the development of policy options. Final report (pdf 1.84Mb). Ensor T, Lievens T, Naylor M. Oxford, Oxford Policy Management, 2008
- ↑ Financial report. Government of Sierra Leone, Ministry of Finance and Economic Development
- ↑ 8.0 8.1 8.2 8.3 8.4 Performance report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010
- ↑ Free health care services for pregnant and lactating women and young children in Sierra Leone. Government of Sierra Leone, Ministry of Health and Sanitation, 2009