July 22, 2016

Back in 2014, before the Ebola outbreak, we did a story on the then recently-released WHO Maternal Mortality Report, in which Sierra Leone was placed dead last in the key Maternal Mortality Rate, MMR, indicator ( this year we reviewed the 2016 report). Shortly after our review of the 2014 report, we looked at the Maternal and Child Health, MCH, Aides, the front-line cadre at the hundreds of MCH clinics spread all over the country, and thus key in the task of improving Sierra Leone's MMR. In their distinctive pink check uniforms, these nurses are often the only source of formal medical care in the country's numerous remote villages. We had received reports that hundreds of new MCH Aides, trained by the government and international partners in government centers in different regions of the country, had not been absorbed into the government medical service two years after they had completed their training, even as this cadre and most other cadres of the medical service were grossly understaffed. As part of our coverage, we interviewed Sierra Leone's Chief Medical Officer, Dr Brima Kargbo, who blithely revealed that it was not uncommon in the districts for nurses to wait eight years to get on the government payroll, even as they 'volunteered' their services at government clinics.

Well the latest reports we have rececived indicate that Dr Kargbo was not very far off the mark. Four years after they graduated, we have learned that at least some of Sierra Leone's 2012 MCH Aides have finally been put on the government payroll and have started receiving salaries. The nurses, who are terrified of being quoted by name lest  they suffer retaliation from their bosses, report that at every tortuous step along the path to the precious government pin code they have had to pay bribes; at the Establishment Secretary's office, at the Ministry of Finance and at the Ministry of Health they have been asked to pay en masse in order for their papers to be processed. During this process they have not dared to enquire whether they will be paid backlog salaries for their years of service since graduation, even though the official directive from their supervising ministry during this period was that they should report daily at centres designated by the ministry. In government circles they are often euphemistically referred to as "volunteer nurses". The pressure to "volunteer" grew even greater during the Ebola outbreak, as medical staff abandoned their posts and the health system all but collapsed. Amazingly, many of these nurses continued to report for duty.

Finally now, starting from May/June this year, at least some of these nurses have received their first salaries including three months back pay. It is only a fraction of the period for which they worked, but they are glad to have received the money and to now be officially employed, and powerless to petition for their due.

We spoke this week with the Director of Human Resources, Ministry of Health, Mr Samuel Coker, who confirmed that "some" MCH Aides had recently been employed but was unable to confirm that this included all the 2012 graduates.  He conceded that the cadre was grossly understaffed but said that government had other commitments and priorities. When asked whether it was true that an even larger number of 2012 SECHNs, the front-line nurses at larger treatment centers and hospitals, still remained to be employed by the government, he replied that he thought "one or two" had recently been hired.

The much vaunted Free Health Care Initiative, then, lavishly funded by international "partners" including WHO, UNICEF and DFID for the benefit of under-fives, and pregnant and nursing mothers, rests on the backs of young nurses who are not getting paid. It's hard to believe that in this day and age people would work full-time for years without pay, but amazingly this is not the only area of government service where this occurs. We regularly receive reports of teachers working for years in government-assisted schools before being put on the payroll. We find indifference and callousness among government officials even including senior doctors and nurses towards this situation. How much, we wonder, does this treatment mold the lifetime attitudes of the young nurses and teachers affected? How much does it shape their attitudes to work, money, their employers and their patients/ students? How much does it contribute to Sierra Leone's very poor health and education indicators?