Now it's free, how to pay for it? Sierra Leone's dilemma.

Zainab Camara cradles her two-week-old baby in the postnatal ward of Freetown’s Princess Christian Maternity Hospital. is is the rst child she has delivered in a hospital. And lucky that she did. Shortly a er giving birth at a regional hospital in Waterloo town, about 30 kilometres outside the capital, Camara began to bleed uncontrollably. She was swi ly transferred to Freetown, where doctors operated to control the bleeding and save her life. In April 2010, Sierra Leone launched its rst free health-care initiative aimed at improving abysmal maternal and child mortality rates (one in eight women risk dying from the complications of childbirth and one in 12 children die before their rst birthday). Had Camara given birth before free health care was o ered, she says, she would never have come to hospital. Camara brings home the equivalent of about US$ 2 a day from the sale of dried sh at Waterloo’s bustling roadside market. A er food and school fees, there is little le for doctor’s visits. Her traditional birth attendant accepted payment in soap bars to help deliver Camara’s rst two children at home. “What made me come in to give birth this time was that I didn’t have to pay anything,” she says. Inspired by similar e orts in Rwanda and Uganda, this initiative o ers free health services to all pregnant women, lactating mothers and children aged less than ve in Sierra Leone. Government hospitals now o er consultations, treatment, beds, obstetric care and drugs free of charge. is is no small feat in a country with only around 80 doctors and 40 government hospitals serving a population of 5.5 million (the World Health Organization recommends 20 physicians per 100 000 people). “It’s the biggest operation of its kind in Sierra Leone,” says Dr Samuel Kargbo, director of the reproductive and child health programme at the Ministry of Health and Sanitation. “In the past 20 years, two things have touched the lives of all Sierra Leoneans – one was the end of the war, and the second is free health care.”