Pieterse Pieternella, Lodge Tom
Department of Politics and Public Administration, University of Limerick, Limerick, Ireland
Department of Politics and Public Administration, University of Limerick, Limerick, Ireland.
Int Health. 2015 Nov;7(6):400-4. doi: 10.1093/inthealth/ihv024. Epub 2015 Apr 23.
Sierra Leone is one of three countries recently affected by Ebola. In debates surrounding the circumstances that contributed to the initial failure to contain the outbreak, the word 'trust' is often used: In December 2014, WHO director Margret Chan used 'lack of trust in governments'; The Lancet's Editor-in-Chief, wrote how Ebola has exposed the '… breakdown of trust between communities and their governments.' This article explores the lack of trust in public healthcare providers in Sierra Leone, predating the Ebola outbreak, apparently linked to widespread petty corruption in primary healthcare facilities. It compares four NGO-supported accountability interventions targeting Sierra Leone's primary health sector.
Field research was conducted in Kailahun, Kono and Tonkolili Districts, based on interviews with health workers and focus group discussions with primary healthcare users.
Field research showed that in most clinics, women and children entitled to free care routinely paid for health services.
A lack of accountability in Sierra Leone's health sector appears pervasive at all levels. Petty corruption is rife. Understaffing leads to charging for free care in order to pay clinic-based 'volunteers' who function as vaccinators, health workers and birth attendants. Accountability interventions were found to have little impact on healthworker (mis)behaviour.
塞拉利昂是近期受埃博拉疫情影响的三个国家之一。在围绕导致最初未能控制疫情爆发的各种情况的辩论中，“信任”一词经常被提及：2014年12月，世界卫生组织总干事陈冯富珍提到了“对政府缺乏信任”；《柳叶刀》主编写道，埃博拉疫情如何暴露了“……社区与政府之间信任的破裂”。本文探讨了在埃博拉疫情爆发之前，塞拉利昂民众对公共医疗服务提供者缺乏信任的情况，这种情况显然与基层医疗机构普遍存在的小额腐败有关。文章比较了针对塞拉利昂初级卫生部门的四项由非政府组织支持的问责干预措施。
在凯拉洪、科诺和通科利利地区进行了实地研究，研究基于对卫生工作者的访谈以及与初级卫生保健使用者的焦点小组讨论。
实地研究表明，在大多数诊所，有权享受免费医疗服务的妇女和儿童通常要为医疗服务付费。
塞拉利昂卫生部门各级似乎都普遍缺乏问责制。小额腐败盛行。人员短缺导致对免费医疗服务收费，以便支付担任疫苗接种员、卫生工作者和助产士的诊所“志愿者”的费用。研究发现，问责干预措施对卫生工作者的（不当）行为影响甚微。
