Moyamba District, south of Sierra Leone, suffered some of the worst devastation in the health sector during the nearly ten years of civil conflict; not only did scores of the then inadequate health personnel flee  their locations, most of the health infrastructure  was also immensely destroyed .

“Before the war there were close to 103 Peripheral Health Units (PHUs), which were reduced to 35 after the war”, recalled the District Medical Officer, Moyamba District, Dr Sartie M. Kenneh.

But even before the war ended, efforts had already been geared towards rendering effective Primary Health Care to the district population.

“When I came in 2000 before the end of the war, the hospital was already being rehabilitated”, Dr Kenneh said adding, “since then we have been working concertedly as the District Health Management Team (DHMT), and through the help of the government and partners such as the national Commission for Social Action (NaCSA), Tera Tech, MSF and CAUSE Canada, we have been able to increase the number of functional PHUs to 84”.

Dr Kanneh noted that out of a burning desire to enhance health care delivery in the district they went to the extent of housing health centers in improper buildings, as a make-shift measure.

“Because of the need and drive of the Ministry of Health and Sanitation (MOHS)  to make health care accessible  to the people, we went the extra-mile of opening health centers in areas where we did not have proper buildings”,  Dr Kenneh explained.

Commenting on the frantic efforts being made by Government to service the population of Moyamba District health wise, Dr Polycarp Uchenna Agu, a Nigerian volunteer posted to the Moyamba Government Hospital under the South–South Health Care Delivery Programme remarked, “I have virtually been working round the clock without any rest, rendering basically clinical services in the hospital and occasionally, Public Health services in some of the PHUs”.

Dr Agu maintained that though much had been done, a lot more remained to be done.

“Let me say that the impact has been felt as we have actually saved lives with the meager facilities available, but government and donor partners should redouble their efforts in making health services  more accessible through the construction of more roads”, he cautioned.

“… good access roads are what I can call the sine qua non of an effective death delivery system”, he added.

 Among the success stories in forging ahead with the Primary Health Care delivery in the Moyamba District, Dr Kenneh catalogued the treatment of particularly Onchocerciasis (River blindness), EPI coverage, Water and Sanitation services and the ongoing registration of births.

Moyamba District being Onchocerciasis endemic, it was but prudent that the DHMT spearheaded by the DMO, recently kicked-started the Community Directed Treatment with Ivermectin (CDTI).

“For a start, our expected therapeutic coverage was 55%; but we achieved 67 % with a 100% geographical coverage of 1000 villages”, Dr Kenneh proudly noted.

 The DMO described the coverage of EPI as “one of our greatest successes” for which he lauded the role performed by the District Council.

“The devolution makes it possible to have a high coverage in this area” he said, noting that at the beginning of the year 2005, EPI coverage came to a record low since 2000.

 “Up to September 2005, we had only 40%; but with the devolution process, we undertook an initiative under the Repaid Result Approach that increased the immunization coverage to 80 %” he said.

Harping on Water and Sanitation services the District Health Superintendent, Joseph Samuel Lawson Cole, highlighted the mass chlorination and cleaning campaigns in the district championed by the Public Health Office working in tandem with the DMHT.

“During the war, most of the wells were polluted either by poisoning or with human corpses and subsequently abandoned by the c community”, he explained.

 Reiterating the crucial participation of the District Council, Mr Cole Said, “generally to say the least the situation is fast improving with the advent of decentralization, in the sense that health services can now be implemented with relative ease through the participation of Council”.

 The District Health Superintendent also noted the remarkable success made in the area of refuse collection, enhanced by the provision of a waste management truck by the World Bank.

“The truck is used only not only for refuse collection, but also for other related health activities such as transportation of drugs from Freetown”, he said.

Over all, Mr Cole lauded the cordiality between his unit, the DHMT and the District Council in implementing health programs in the district, noting the central role of the Community Children’s Radio in disseminating Public Health messages.

In his judgment Joseph Benson Cobba, Chairman of the Health and Sanitation Committee, Moyamba District Council said, “the health situation is fairly good” adding, “my job is to see that health delivery services reach the farthest communities of the district”.

  He recalled for example, the massive registration of births that he said had evaded residents of the district for many years.

“The DHMT in Collaboration with Plan Sierra Leone registered about 11, 000 children 0-5 years, who had never been registered before” he stated.

 The exercise, he said, would provide essential data in the event of making estimates for health related developments.

The Health Committee Chair also brought to the fore the unprecedented immunization of children and pregnant women in the district.

“The exercise also benefited non-pregnant women, who were accorded the opportunity of taking Tetanus Toxide –TT”.

In corroboration to the District Superintendent, Mr Cobba mentioned the training of well owners in the use of chlorine in their wells, which were indiscriminately contaminated during the war.

He lauded the regular supply of drugs to not only the Government Hospital in Moyamba town, but also to the PHUs.

“We have just received a consignment of drugs greater than ever before, which included Atesunate and Amodiaquine plus Fancidar for Malaria treatment as Chloroquine is no longer effective”, he revealed.

This latest supply of drugs is indeed a welcome development in fighting the high prevalence of Malaria in the district as disclosed by the DMO.

“Malaria stands at about 40% of  all the out-patient cases both in the hospital and the PHU; and about 40% of Under -5 mortality is due to Malaria”, Dr Kenneh stated.

He attributed this high rate of Malaria to the fact that there had not been any long-lasting anti-Malaria therapy in the district, using insecticide-treated bed nets.

“We have only been giving presumptive therapy with the use of fancidar to pregnant women” he said.

On the HIV/Aids front Dr Kenneh spoke of various activities towards combating the dreadful disease, focusing particularly mother-to-child transmission.

 “Currently we are conducting voluntary testing for HIV/Aids, and have earmarked seven sites in addition to the training of CHOs in the management and case detection of HIV Aids in their centers”, Dr Kenneh said. 

While cataloguing the numerous obstacles in the way of Primary Health Care in the District, the Matron In-Charge of the Government Hospital, Miss Susan Charles, commended government’s efforts in that direction.

 “So far, we thank government for the efforts they are making in the Health Care in Moyamba. But let me appeal to government for special incentives for nurses working in the interior as it obtains in other countries like Ghana and Nigeria”, she said.

Seventy-two years ailing Paramount Chief of Kaiyamba Chiefdom, the district head quarter, noted that every section of his chiefdom has a health center manned by trained nurses.

“We have seven sections in Kaiyamba chiefdom and each has a health center”, he said.

Paramount Chief (P.C.) Las Lamin commended the commitment being demonstrated by the two Medical Officers attached at the Government Hospital, describing them as models to emulate.

 “We have two trained doctors, one Sierra Leonean and one Nigerian, who was posted here on voluntary service, and they are both very hardworking” assured P.C. Lamin.

Generally, the Chief concluded, there had been marked improvement in the over all Health Care delivery compared to the past.

To sum up, Health Care in the Moyamba district is forging ahead, despite deeply rooted constraints.