The free health care initiative: how has it affected health workers in Sierra Leone?
In this new era of global health (see JPHP 29:4), we sense palpable enthusiasm in Sierra Leone. Americans come for undergraduate internships, medical student electives, and health professional opportunities; that is how we met. Over the past 3 years, we have found few people understand the health system dilemmas in the world’s poorest country. In America, records are on the internet and easily accessible, but in Sierra Leone, important documents, like a health and human resource report or a community health worker training manual, can be found in a box sitting in an administrator’s office; or on demand, the Ministry of Health official may be able to provide an electronic copy. Infrastructural lags in Sierra Leone lead to information asymmetry, and perhaps, misunderstandings of health system problems. For example, Sierra Leone has had a medical school since 1988. We wonder how many international students and professionals arrive in Sierra Leone aspiring to help the government solve their health system problems. We present here examples of how Sierra Leone works to solve its health and human resource crisis. In the Government of Sierra Leone, Ministry of Health officials such as Dr Sandi, Director of Human Resources, know the Brain Drain problems. According to a 2007 report of the Ministry’s Annual Review and Planning Workshop, the country had 67 medical officers and 225 nurses. According to the World Health Organization’s Workload Indicators and Staffing Needs, Sierra Leone should have a minimum of 300 medical officers and 600 nurses. Dr Sandi wrote a ‘Report on The Annual Health Review and Planning Workshop’, confirming in 2007 that doctors and nurses immigrate to the United States and other countries for better salaries, postgraduate training opportunities, and improved working conditions. These problems