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civil society

Justice in health care delivery: a role for Sierra Leone’s paralegals

Margaux Hall's picture

I recently attended a community paralegal training on promoting accountability in health care delivery in Makeni, Sierra Leone. During the training, a community paralegal named Elizabeth Massalay talked about bringing her niece to a clinic in Moyamba district to receive immunizations that the government provides free of charge thanks to the Free Health Care Initiative (FHCI), which offers free health services to pregnant and breastfeeding women and children under five. Mothers queued for free immunizations, painting a hopeful picture for a country that ranks 180 out of 187 in the 2011 Human Development Index and where almost one in three children die before reaching the age of five.

However, against this promising backdrop, Elizabeth saw that the nurse was demanding six cups of rice from each mother before providing the immunization. Elizabeth was witnessing how breakdowns within state institutions—including absent nurses, improper user fees, and “leakage” of up to 30% of FHCI drugs (according to government and UNICEF statistics)—undermine health care delivery. Responding to such breakdowns requires an understanding of health policy and regulations—what the state must provide and to whom—and knowing where and how to apply pressure when the state fails to do so.

Civil society helping us do better in health

Cristian Baeza's picture

I spent a great couple of days earlier this week with representatives of civil society organizations (CSOs) from around the world who are members of our World Bank – Civil Society Consultative Group on Health, Nutrition, and Population. When it was launched earlier this year, we envisioned the consultative group as a forum for CSOs and our Bank-wide health team to share perspectives and discuss frankly any concerns we may have about our respective work in health, nutrition, and population, and to learn from one another. So it’s exciting to see this group beginning to move from theory to action.