Strengthening Health Systems in Sierra Leone during COVID-19

The challenges of Sierra Leone’s healthcare system are well-known: chronic underfunding and a shortage of qualified workers coupled with an underlying high burden of both communicable and non-communicable diseases. This combination makes building a strong and resilient system slow and ongoing work.

It is in this context that King’s Global Health Partnerships (KGHP) has been working since 2013 and where, since March, it has supported the country’s response to COVID-19. The country has seen a little less than 1,700 positive cases to date; however, confirmed community transmission and limited testing capacity mean that this number is likely a vast underestimation.

The King’s Sierra Leone Partnership (KSLP) has centred primarily around Connaught Hospital, Freetown’s main tertiary referral centre and the destination of COVID-19 suspected patients in the Western Urban Area. Working in partnership with the hospital management and personnel, KSLP staff and volunteers were reassigned to provide crucial support and training to frontline health workers.

Triage of suspected COVID-19 cases

Early and decisive action back in March was crucial to keeping the hospital open at a time when other facilities in Sierra Leone stopped taking new patients or were forced to close due to positive cases amongst healthcare staff. A new streamlined triage process and the training of screeners at the hospital’s main gate enabled the quick and safe isolation of suspected COVID-19 patients. This protected the rest of the hospital, keeping it open for thousands of people to continue to receive care.

The infectious diseases unit — created on the recommendation of KSLP in 2016 after the Ebola epidemic — has now become a fully functioning COVID-19 isolation unit. Admission and management protocols have been created in line with the ever-changing COVID-19 evidence base and ensure that patients receive the best care available.

Organising the 24/7 supply of oxygen cylinders from the DFID-funded oxygen factory at Connaught Hospital has also been crucial for the acute care of COVID-positive patients while mentoring from KSLP clinical volunteers and staff has helped local healthcare workers feel more confident and motivated.

COVID-19 training and mentoring for healthcare workers

In the rest of the hospital, specially designed COVID-19 training for over 200 staff has been run to give workers the support and knowledge to keep themselves — and people in the communities where they live — safe. “If you look at the situation under which we’re, working, we have to be optimistic” notes Dr Mamadu Baldeh, head of the Infectious Disease Unit at Connaught Hospital. “That’s the best you have to keep on pushing.”

Psychosocial support for patients and relatives

For many, COVID-19 has brought unwelcome memories of the 2014 Ebola epidemic, during which isolation and separation from loved ones was necessary and painful. To help to mitigate this, a dedicated psychosocial team has been developed to provide care for patients and their relatives while they are isolated. Emotional support and almost 50 care bags containing food and personal care items have been provided to mitigate the effects of family members unable to enter the isolation unit. These measures have helped to reduce patients absconding — an ongoing issue in other countries fighting COVID-19 on the continent — to just a handful of cases.

Strengthening health systems beyond Covid-19

The reality is that coronavirus is just one of the healthcare challenges that Sierra Leoneans face in their day-to-day lives. Malaria, HIV and tuberculosis pose a real risk and — as the high numbers of cases during Ebola prove — cannot be neglected.

To that end, existing programmes — such as the Comic Relief-funded ‘Strengthening Health systems to Improve Fever management’ project (SHIFT) — have been adapted to ensure health strengthening is happening across hospital units. For example, better access to malaria rapid diagnosis tests (RDT) at triage and IDU has freed up resources at the on-site laboratory while improving patient care, a win-win situation.

The pandemic continues to test the resilience of Sierra Leone’s healthcare system. But, at the same time, it provides an opportunity for KSLP and its local partners to build the strength of its health workforce, gain the trust of patients and optimise the quality of its healthcare to save lives.

– Ben Whitelaw, King’s Global Health Partnerships.

King’s Global Health Partnerships works with partners in Somaliland, Sierra Leone, Democratic Republic of Congo and Zambia to strengthen health systems and provide people with high quality health care.

To learn more about our work, please visit our website or Twitter: @KingsGHP.