The intricacies involved in rebuilding clinics in Sierra Leone

By Jenny Lei Ravelo 15 May 2015

The opening of the Healey International Relief Foundation Monsignor Daniel Sullivan Health Clinic in Freetown, Sierra Leone. Photo by: HIRF

The Ebola outbreak devastated already weak health systems in Sierra Leone, and cut down the number of already few doctors and health care workers in the country.

But it was not the only problem in Sierra Leone. Many of its hospitals and clinics were run down, ravaged by the country’s 10-year civil war. Some of them continue to operate, but they lack equipment, basic necessities like electricity and proper sanitation facilities, or have too small a space.

Not all of them are also accessible to everyone, including Sierra Leone’s war survivors, many of whom have suffered some form of physical injuries and lost their hands or feet.

And most of these facilities weren’t prepared for an emergency like Ebola.

U.S.-based Healey International Relief Foundation learned all that while it was doing an assessment of a string of clinics across the country, totaling more than 40. The clinics had been functioning well, as part of the Catholic National Health Organization, until civil war came.

The assessment is part of a huge project the foundation is embarking on: to rebuild around 30 charitable clinics in the towns of Bo, Freetown, Kenema and Makeni.

Executive Director Benjamin Parra is aware it’s a “huge undertaking” that would require not only significant financial resources, but also a defined strategy that would ensure their sustainability.

The clinics are meant to serve the poorest of the poor, so raising their own resources by relying on patients is too much to expect. But they also cannot rely much on the government, especially now that it is still reeling from the impact of Ebola. Faith-based groups can provide support, but might only be to a “certain point.”

The answer, the foundation believes, is in a social venture.

But Parra so far is mum on the details. At present, its focus is on getting the program going, ensuring important details in rebuilding the health clinics are not overlooked.

The clinics project

The idea behind the clinics rebuilding project is to ensure the provision of primary health care to underserved communities in Sierra Leone, with a focus on maternal and infant care.

Maternal and child mortality in Sierra Leone is among the highest in the world. And while statistics show it has improved significantly over the past decade, there was fear the gains were reversed when Ebola happened, with fewer pregnant women able or willing to give birth in hospitals or clinics, and the number of birth attendants dropping.

But the foundation learned it also had to take into account the needs of people with disabilities, and that these clinics need to be prepared for the next Ebola — or another infectious disease.

So apart from incorporating access paths for PWDs, Healey is also including a triage area — that part of the clinic where those suspected of suffering from an infectious disease can be pre-screened and isolated — in the design.

All of these, Parra said, were a result of lessons learned from the Ebola epidemic.

But that’s not all. The foundation is also ensuring that personnel will be able to live close enough to the clinics.

“We have to provide living quarters for them,” Parra told Devex. “As you have a maternity care, someone has to be there 24 hours.”

The foundation already made this possible in the first clinic it finished — this one from scratch — and inaugurated in March. In line with Healey’s vision for all the clinics, the HIRF Monsignor Daniel Sullivan Health Clinic is open for everyone but will specifically benefit amputees of the war living in Saint Stephen’s Home in Freetown.

The foundation is also working with other organizations to train community health officers to ensure the clinics will be staffed.

The pilots

Instead of plowing ahead and building all 30 facilities simultaneously, Healey opted to first start with five pilot clinics, which would hopefully provide better data on how to design and build the next ones better.

The board decided to do “little by little, learn from what we don’t know, and then go to the next phase.”

“The thought was, we could sit down, and spend thousands if not millions of dollars in planning everything and doing everything … or we could [do it] and learn from it,” Parra said. “If we had good data, of how all of these things work, on training and everything else, [then it would’ve been easier], but we don’t.”

Healey is still in very preliminary discussions with multilateral organizations, faith-based groups and what Parra calls “social conscience investors” for the financing of the clinics, which the foundation assessed would require $12 million — which already covers training for the community health workers.

While Parra declined to share how much the foundation has secured in pledges, the project could prove to be a good indicator of just how much the international community has learned from the Ebola outbreak.

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About the author

Jenny lei ravelo 400x400
Jenny Lei Ravelo@JennyLeiRavelo

Jenny Lei Ravelo is a Devex senior reporter based in Manila. Since 2011, she has covered a wide range of development and humanitarian aid issues, from leadership and policy changes at DfID to the logistical and security impediments faced by international and local aid responders in disaster-prone and conflict-affected countries in Africa and Asia. Her interests include global health and the analysis of aid challenges and trends in sub-Saharan Africa.


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