Sophie Witter: So, how did you come to attend the CoP meeting?
Aminatu Kanu: Sierra Leone was asked to send a delegation of four people, and I was helping to organise that. I am the Ministerial Leadership Initiative adviser, and we were sponsoring the delegation. I came to give moral support to the team!
Ateiza Issa: I work for the National Health Insurance in Nigeria, which is implementing fee exemption. So I was invited to share our experience as a policy implementer.
Any highlights for you from the first day?
AK: I have found some things quite puzzling about how policies have been designed in other countries. For example, we learned that in Benin caesareans are free but normal deliveries have to be paid for. I can’t quite understand how that makes sense.
But I have also learned some things – for example, I was interested in the Nigerian approach of having an independent agency responsible for implementing free care. I think that perhaps that is a good idea – it might enable a multisectoral approach, independent of the Ministry of Health. And later on, it might make developments like the national health insurance easier to introduce. That is something that I will mention to the Minister when I get back.
AI: Well, I have heard about a lot of new experiences. One of the most interesting things I have learned is that across the region, none of the policies covers the costs of accessing the first level of care. That is a big gap, as we know that the second delay is one of the most important factors behind women dying.
Aminatu, does Sierra Leone have a clear vision of where it is going, in policy terms?
AK: The President and Office of the Prime Minister would like to see more people covered than under the current free health care policy. So we have a clear vision but it is not so easy to implement, given our high levels of poverty and unemployment. We are studying the example of countries like Ghana to learn from them.
In addition, we face an acute shortage of skilled staff. We have only four gynaecologists and two retire soon! So we need to look at improving training. We want to have one midwife in every Primary Health Care Unit (of which we have some 1,300) to increase skilled attendance. We are also training community midwives, and setting up pregnant women’s clubs to increase awareness and access . So there is a lot going on. We also have a big problem of teenage pregnancies (one in three teenagers gets pregnant), so adolescent sexual health is high on the agenda. Under the Child Rights Act, marriage under 18 is forbidden but there is still a way to go to enforce that.
What are your hopes or expectations from this meeting?
AK: I think that there should be an African model to ensure that everyone has access, rather than just some countries offering certain types of free care (which also creates problems of people crossing the borders to access a better package). I am hoping that out of this meeting we will get concrete advice for policy-makers about how to implement these free care policies and how to make them work.
The other thing I’d like to see from the CoP is some sort of advocacy. It is all very well sharing knowledge, but that doesn’t bring about change. Something needs to be done! Commitments are made, but not followed up on. I think that policies should be more than papers signed at meetings – we also need to think about how to empower people to demand services from their leaders.
Based on the discussions so far, what would you recommend to the members of the CoP?
AI: I think they should contribute to placing all of the useful information that they have in their countries onto the CoP website. My second recommendation would be that each of the country groups represented here agree to act as focal points for the CoP when they go back home.
AK: Well, I think that the CoP needs to think about how to handle contexts where internet access is poor, like Sierra Leone. I like the idea of Googlegroups, but even in Freetown getting access to the internet is not so easy (for example, I can’t access it in my home). So maybe we should think about local chapters, where people can bring in information and work together as a group.
Many thanks, thanks for your thoughts, and I hope that you continue to enjoy the next two days of the workshop