Fatmata (not her real name), is a quiet and proud young woman from the Mende Tribe, who sits calmly beside a hospital bed. She is caring for her daughter, a small figure of no more than two years old, who is suffering from the effects of malnutrition. On the same bed lies her one-month-old baby son, swaddled and sleeping peacefully.
Fatmata’s daughter has been receiving life-saving IV fluids and glucose boosts to help revitalise her tiny body. The hospital ward is clean and well attended by nurses, with beds cocooned in protective mosquito netting. The ward is open aired, allowing sea breezes to cool the humid and hot March conditions, prior to the wet season due in June.
Even before Sierra Leone was officially declared Ebola free at the end of 2015, Sierra Leoneans, international actors, the government and organisations like Crown Agents have been looking to the future. The post-Ebola landscape is a very different Sierra Leone: people are now constructively cautious about stopping it coming back, rather than fearful of its indiscriminate assault on the country.
Response has turned to recovery. The aim now is to build a stronger all-round healthcare system that will allow Sierra Leone to face or even head-off a similar situation in future. No one is in any doubt about the scale of the task, though: even pre-Ebola, Sierre Leone suffered the highest infant and mother mortality rate in the world.
As a long-standing partner of Sierra Leone, Crown Agents has stayed in-country to work on the post-Ebola rebuilding. Our partnership with the International Procurement Agency, under the CAIPA brand, is now delivering health commodities for the free health care initiative, which is providing lifesaving medical and pharmaceutical supplies to pregnant women, lactating mothers and the under-5s.
Many of the other players remain too: the initiative has been established by DFID and Unicef with the Sierra Leonean ministry of health’s national pharmaceutical procurement unit (NPPU) and assistance from the Clinton health access initiative (CHAI). Our role in the ‘last mile logistics’ of the project involves working very closely with the NPPU to get the commodities to wherever they’re needed, regardless of how remote or inaccessible the locations.
‘Last mile logistics’ in challenging environments is a particular speciality of ours, which is just as well, as distribution to the Bonthe islands, in the country’s Southern Province involves a journey of 250 kilometres by road and by sea. The first 142km on Chinese built tarmac roads from CAIPA’s Ferry Junction Warehouse in Freetown, to Moyamba Junction is the easiest part. Then there’s 88km of well-graded dirt and watered down roads to the town of Mogbewa.
Next is 30km on rough and undulating sandy tracks, cut through the jungle, to reach the remote coastal town of Yargoi. Our Toyota Land Cruisers – which are actually repurposed Ebola Ambulances – are the ideal choice for these conditions. After that, though, we have to take to the water, transporting the value chain in locally built boats, powered by 15hp Evinrude engines.
It’s then a further 2.5 hours of navigating the inlets and sandy shallows before we finally reach the main island of Sherbro. All this work, however, means that five basic emergency obstetric and newborn care (BEMONC) centres on the islands are receiving vital equipment for emergency life-saving care, which will ultimately help bring down maternal mortality rates.
Our experience from Ebola has been crucial. We know the habits, conventions and potential hindrances of the environment, and can now often be one step ahead of them. Beyond the physical delivery of the equipment, the free health care distribution team is also carrying out extensive engagement work to gain the trust and involvement of communities. We and the NPPU are working with NGOs like Health Alert to reach out to these communities. We’re using popular media such as radio adverts and jingles to make sure women and children know that they have a right to these services, irrespective of race, ethnicity, religion or gender.
Britain’s ODA spending comes under daily scrutiny in the media. It is work like what’s happening in Sierra Leone, however, that provides a living, breathing example of what it’s achieving. It’s helping a country that has been crippled by a humanitarian disaster to rebuild and strengthen, with its eyes on the long-term. We understand our obligations to taxpayers to ensure value for money, and are fully on board with DFID’s actions as one of the global leaders in ensuring transparency and accountability of its suppliers. This pressure should continue in a way that will drive better services – but not hold back real change.
That real change is being seen in the women surviving previously life-threatening deliveries; in the hospital staff writing clear and efficient business plans to organisations like DFID for what they could do with repurposed Ebola equipment; in the organisations like ours using our local knowledge to think in an innovative way and put items like additional storage tents from the Ebola response to use in communities where we’ve seen a need for them.
With the storage tent we transported to Bonthe, we also oversaw the transportation of necessary generators, pumps and repair kits, as well as the instructional training for the local storeman: a clear demonstration of holistic thinking and the new direction of the Ebola legacy.
The real change is looking at what’s next and then doing it well and doing it wisely. As we work with our partners in-country and in the UK, people like Fatmata and her children will be part of a stronger and healthier population and a brighter future for Sierra Leone.
Content on this page is paid for and provided by Crown Agents, a sponsor of theGuardian Global Development Professionals Network.
