The provision of equitable access to quality and affordable health care for all without undue financial hardship to achieve Universal Health Coverage (UHC), as defined in target 3.8 of the SDGs, is a national priority for many low- and middle-income countries, including Sierra Leone. The Government of Sierra Leone (GoSL) has adopted progressive policies and measures to expand service coverage and lower or eliminate user charges for financial risk protection from health expenditures. The UHC Roadmap has been developed and launched in December 2020 as a
strategic direction to guide the country towards achieving UHC. The vision of the UHC Roadmap is aligned with that of the new National Health Policy (NHP) and the National Health Sector Strategic Plan (NHSSP) for UHC, and being built on a myriad of policy framework, including the Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH) Policy/Strategy 2017–2021, the National Community Health Worker (CHW) Policy 2016–2020 and 2021-2025, and the Multisectoral Malnutrition Reduction Strategic Plan 2019–2025.
Since its launch of Scaling-Up Nutrition (SUN) in 2012, the GoSL has strengthened coordination and has been convening development partners to address food and nutrition crisis prevention and management. Despite the delays and significant setbacks on the overall health outcomes caused by the Ebola outbreak in 2014-15, SUN has been contributing to building resilience among the most vulnerable population. Indeed, the prevalence of stunting fell from 44.9% in 2010 to 26.4% in 2017 (World Development Indicators 2018 and MICS6 2017). The trend hit a wall in 2019, however, when stunting rates crept back to 29.5% with significant geographical disparities (DHS 2019). In response to this and related nutrition-driven health concerns, the Directorate of Food and Nutrition (DFN) of the Ministry of Health and Sanitation (MOHS) has implemented a set of high-impact nutrition-specific and nutrition-sensitive interventions to improve maternal, newborn and child health and nutrition as part of the Basic Package of Essential Health Services (BPEHS).
At the health facility level, the following nutrition-specific interventions offered to the public: (i) growth monitoring and promotion, including nutrition screening, identification and management of severely malnourished children through the Integrated Management of Acute Malnutrition (IMAM) program; (ii) counselling of pregnant women, mothers and caregivers on optimal maternal, infant and young child nutrition (IYCN) practices during antenatal care and vaccination visits; (iii) biannual vitamin A supplementation of children under-five and post-partum women; (iv) biannual deworming of children under five and pregnant women, and; (v) iron folate
supplementation of pregnant women. Concurrently, community-centered nutrition-related activities are being carried out to promote good nutrition knowledge and practices through CHWs, mothers support groups (MSGs) and community radio among others.
At the community level, the peripheral health units (PHUs) have been guiding CHWs in supervising MSG activities. Under this arrangement, CHWs have been serving as a link between MSGs and PHUs to strengthen nutrition referrals and defaulter tracing as well as reinforced health, nutrition, sanitation and hygiene messages at the community level. With 80 per cent of the MSG members being female, MSGs are in a unique position to support and complement efforts of the male dominated CHW network in promoting gender specific issues on maternal health and nutrition. The collaboration of CHWs and MSGs is expected to support the scale up of the following nutrition-specific interventions offered to the public at the community level: (i) growth monitoring and promotion including nutrition screening of children under five years of age (not just sick children); (ii) referral and counselling of children with moderate acute malnutrition to MSG; (iii) referral of children with severe acute malnutrition (SAM) to health facilities; (iv) follow-up of SAM children who defaulted from the IMAM program; (v) household visits and counselling of a wider group of pregnant women, mothers and caregivers on optimal maternal, infant and young child nutrition practices; and (vi) food demonstration on preparation of nutrient-dense Complementary food using locally available ingredients.
The partnership is designed to allow CHWs to have more time to focus on the delivery of community-based nutrition-sensitive services such as: (i) integrated community case management of common childhood illnesses such as treatment of diarrhea; (ii) household visits and counselling of pregnant women and their family members to promote positive pregnancy experiences such as encouraging completion of required antenatal care visits, sleeping under mosquito nets; (iii) household visits and counselling of pregnant women, mothers and caregivers on optimal 1 3 out of the 15 members of each MSGs are males following the MOHS MSG guidance document sanitation and hygiene promotion, sexual reproductive health, girls education, and caring practices; and (iv) defaulter tracing of children under five and pregnant women who have missed immunization, micronutrient and deworming schedules. Interventions in the aforementioned package of nutrition-specific and nutrition-sensitive interventions have been identified as evidence-based interventions in the framework for actions to achieve optimum fetal and child nutrition and development in the Lancet 2013 maternal and Child Nutrition series.