Update by MoHS for Health Development Partners

1. Update by MoHS for Health Development Partners Strategic Plan - Yayah Conteh – Donor/NGO Liaison RCH Update - Dr Samba – Child Health Programme Manager Health Care Financing - Mike Amara – Health Economist

2. Reproductive Child Health: Progress Update 3-month district work plans - Update on implementation and brief overview of the findings • Funded by UNICEF • Extracted from annual district RCH plans • Detailed activity plans developed per district with timelines • Implementation supervised by members of the RCH working groups • Implementation has been completed and a review conducted • Key issues emanating from the district reports were as follows: • Timely provision of fuel for district cold rooms enhanced cold chain capacity • Timely provision of funds for distribution of vaccines to PHUs improved accessibility • District coverage for some antigens (vaccines) has increased significantly • Provision of incentives to maternity staff has increased motivation and hospital deliveries

3. Reproductive Child Health: Progress Update Development of the 6 month district plans (update on progress to date) • The basis of the 6 month plan is to maintain the success accrued by the 3 month plan (full scale implementation will commence next year with capital expenditure and the three and six month plans deliver essential operational activities) • The plan was developed in July 2009 during a meeting at Hill Valley • The focus of the plan is to improve access to service delivery and includes: • Outreach allowances to PHU staff • Fuel for district cold rooms and outreach activities • Incentives for maternity staff to reduce hospital charges • Maintenance of cold chain and vehicles • Support to DHMTs to conduct regular supportive supervision • Plan has been submitted to DFID (the plan is funded by DFID from September and disbursed through UNICEF) Development of central costed plan • Need to ensure that the four central programmes of Child Health, Reproductive Health, Nutrition and School and Adolescent Health are funded to ensure effective supervision, dissemination/distribution of guidelines and protocols

4. Basic Package of Essential Services – the package is nearing completion and need to plan implementation The development of a Basic Package of Essential Health Services core part of the new Health Sector Strategic Plan. This approach is novel because it is seen as a high impact cost effective primary care service delivery mechanism aimed to scale up health services rapidly, including sexual and reproductive and child health services. • Objectives • To address the unacceptable high child and maternal mortality and morbidity in the country by ensuring the provision of minimal essential quality of care for all. • The concept of the Basic Package of Essential Health Services (BPEHS) is that, all of the services in the package must be available as an integrated whole, rather than being available in piecemeal or as individual service. • The key elements in the basic package of essential health services are characterized by services which have the greatest impact on the major health problems (especially that of maternal and child health), services that are cost-effective and services which could be delivered to give equal access to both rural and urban populations. • Next Steps • Deadline for comments on the BPEHS by end of September • The Ministry of Health and Sanitation expects that all partners and key stakeholders involved in the delivery of health services in Sierra Leone will use this BPEHS as the basis for planning and implementing their health programs/support. • A proposal has been submitted to ADB to fund part of the implementation. The proposal contains the following • Sensitization of the public on the essence of the BPEHS (what they should expect) • Launching of the BPEHS • Assessment of facilities against the BPEHS standards for accreditation • Increase capacity of facilities to meet the standard criteria • There are still funding gaps for full implementation

5. RCH – Governance: currently not meeting regularly and potential duplication with other meetings. Is a revised structure required? Joint National and International Expert Panel - Every two years - Convened MoHS and chaired by expert - National and International Experts - Not yet met Overall Policy and Strategic Direction Partner Coordination, Policy Endorsement & Information Sharing • Inter Agency Co-ordinating Committee for Reproductive Child Health • Major partner co-ordination takes place and where policy issues, programme strategy and financial matters on RCH are decided. • Quarterly meeting convened by MoHS and Chaired by the Minister of Health • Last met 19th March 2009 • Working Groups • Planning and Training • M &E • Health Communications • Logistics • Technical Co-ordinating Committee for Reproductive Child Health • Monthly (Tuesday at 10am) • MoHS, RCH Programme Managements, UN Agencies, NGOs, Faith based orgs and WG Chair persons • Outputs of the Working Groups are appraised for technical correctness prior to submission to RCCRCH • Convened and Chaired by CMO and reports to the ICCRCH through its chair person and have has major responsibilities for co-ordinating the activities of the ICCRCH working groups, RCH programmes and partners technical officers • Provides policy and strategic direction advice to the ICCRCH • Last met 18th March 2009 Strategy, Implementation and Operations District Inter Agency Coordinating Meeting Monthly meeting Partner Coordination, Convened and chaired by CM/DC DHMTs Monthly Meeting Programme Implementation Chaired by DMO District Level Co-ordination

6. HealthFinancing – Free Health Care – plans are moving quickly and GoSL announced its intentions at UNGA • The Government of Sierra Leone has stated its intention to deliver free healthcare to pregnant women and under 5’s. Plans are developing quickly following recent announcements at the UN General Assembly and in the run up to the Sierra Leone Conference (SLC) • The goal, of the Government of Sierra Leone is to provide universal access to quality health care in line with the Millennium Development Goals. • Health care costs remain very high in Sierra Leone, resulting in poor utilization (on average 0.5 visits per person per year). Out of pocket expenses of about 70% remain among the highest in Africa (NHA Report, 2007). • A review commissioned by the Ministry in 2007 established that even modest charges tended to exclude over 50% of the population from seeking health care and exemption systems in current use do not seem to work (Health Financing Assessment, Oxford Policy Management 2008). • The first phase of this goal will see the immediate provision of free quality health care to pregnant women and under five children once additional funds are secured to deliver a one-year Emergency Programme of Support. • The second phase will provide universal access to free quality health care for all vulnerable groups through the delivery of a 5-year Programme of Work. Additional funds are also sort for full implementation.

7. HealthFinancing – Free Health Care – it will deliver on this through attracting funds at the Sierra Leone Conference PHASE 1 : free quality health services for pregnant women and under five children: • Phase 1 Proposal Development Stage (August-November 2009) – working with development partners to establish what evidenced-based strategies need to be put in place to successfully implement this policy and how much it will cost. This will be inclusive of drugs, human resource requirements, and an incentive scheme to top up health workers salaries. • Phase 1Inception Phase (December 2009 - April 2010) – using experts from other countries who have implemented healthcare, commence Phase 1 with an inception period to carefully plan how the GoSL will roll out implementation of the emergency programme of support. This will include consultation with a wide range of stakeholders to ensure experience gathered and ownership of the policy. It will also include the finalisation of the governance system that will oversee implementation of this Emergency Programme of Support. • Phase 1 Implementation Phase (May – December 2010) – project launch and communication and announcement of the programme, and the programme goes live with accompanying measures to ensure it is enforced. A second phase where MoHS moves to a sector wide approach and longer term support