The Ministry of Health & Sanitation (MoHS) in Sierra Leone is one of the largest in the civil service, and has the most challenging responsibility of ensuring a healthy nation. Against this background, the MoHS had seen the highest turn-over of ministers since the introduction of multi-party democracy in 1996. Whereas ministers of other ministries enviably had the opportunity of serving for 5-10 years, the appointed ministers of health were hardly given the opportunity to serve that long. But “why ministers of health are sack-prone?” is the focus of this article. Most importantly, this piece will attempt to provide insightful contribution on the role of MoHS and how its performance can be optimized to impact population health through synergy, collaboration and complementarity with other ministries, department and agencies (MDA).
I have noted in earlier write-ups that, the issue of health is not the sole responsibility of the health sector. Traditionally, society has looked to the health sector to deal with its concerns about health and disease. But it must be known that, the absence of healthcare is not the prime factor that determines whether someone will fall ill or not. Certainly, mal-distribution of health care – not delivering care to those who most need it – is one of the social determinants of health. But the high burden of illness responsible for appalling premature loss of life arises in large part because of the conditions in which people are born, grow, live, work, and age. In their turn, poor and unequal living conditions are the consequence of poor social policies and programmes, and unfair economic arrangements.
Let’s take a look at the slums, the access-challenged mountainous settlements, the poor housing conditions, the erratic supply of water with majority of the population relying largely on wells and ponds for drinking water; the high illiteracy levels and the poor quality of education; the nation over-reliance on imported rice and other food stuff means many can ill-afford the right amount and quality of food for survival; hence the growing malnutrition especially in the vulnerable populations of women and children. All of these pose serious threats to the health of a nation. The MoHS, for example does not have a direct role to provide water for the population; nor on having good roads across the country to facilitate healthcare service delivery. The MoHS is not responsible for the food security of the country, nor does it responsible for job creations that are needed to alleviate poverty and enhance citizens’ capacity to purchase healthcare services. It is glaringly clear thus that, the environments in which people live, work, learn, and play have tremendous impact on their health.
In the place of always blaming the health sector for the poor health outcomes of the citizenry and the unfair changing or sacking of the ministry political heads, it is but rational to understand and appreciate that, the responsibility for the social determinants of health falls to many non-traditional health partners, such as housing, social welfare, transportation, education, energy, and employment agencies. Given the many factors that influence health, no single entity can be held accountable for health outcomes of the citizenry; rather it should be considered a shared responsibility with other sectors including the private sector.
What is critical therefore is MoHS to work with those MDAs and development partners who are best positioned to create policies and practices that promote healthy communities and environments, and secure the many co-benefits that can be attained through healthy public policy. The World Health Organization (WHO) is pushing countries to adopt the Health in All Policies (HiAP) approach to addressing the inequities and inequalities in health. Health in All Policies is a collaborative approach to improving the health of all people by incorporating health considerations into decision-making across sectors and policy areas. Health in All Policies is based on the recognition that our greatest health challenges—for example, chronic illness, health inequities, climate change, and spiraling health care costs—are highly complex and often linked. Promoting healthy communities requires that we address the social determinants of health, such as transportation, education, and access to healthy food, economic opportunities, and more. The goal of Health in All Policies is to ensure that decision-makers are informed about the health, equity, and sustainability consequences of various policy options during the policy development process.
The current political leadership of MoHS is the best mix ever for MoHS; a combination of an experienced academician/administrator (Dr Alpha T. Wurie as Minister) and a practitioner (Dr. Anthony Sandi as Deputy Minister). Dr Sandi as a Professional Public Health Specialist, has graduated at all levels of the Sierra Leone health system, having worked as Medical Officer, Medical Superintendent, District Medical Officer and Manager for Human Resource for Health. There is a palpable determination in the Wurie-Sandi leadership to bring in the needed reforms, including the promotion of collaborative and equitable partnership with other MDAs and development partners for an appreciable return on investment in the health sector. Whilst the battery of health professionals in MoHS are keen to give their support to the Wurie-Sandi team for an improved health outcomes of Sierra Leoneans, it is prudent to note that, the efforts of the health sector alone cannot change the appalling health statistics of Sierra Leoneans. His Excellency the President, Rtd Brig Dr. Julius Maada Bio should galvanize the energies of other sectors using the HiAP approach, and provide the needed support to the health sector to ensure his plans for the health sector achieved for a prosperous Sierra Leone.
A cholera outbreak that is secondary to lack of portable drinking water; an increase in teenage pregnancies that is facilitated by family dislocations and poverty; the increase in maternal mortality rates that are linked to poverty and difficult terrains among others, should no longer warrant the sacking of the hard-working ministers of health; but rather an examination of policies of other ministries that are equally responsible to avert some of these issues must be done, and push for a broader collective and sustainable socio-ecological interventions.