After a bloody conflict Sierra Leone is experiencing a steady improvement in its security and political situation. However, several challenges remain.
The Health Programme continues to support government efforts by contributing to the revitalization of primary health care units and promoting capacity building of district health service institutions. Routine and supplementary immunization activities are also being implemented. The full immunization coverage for children under one year has increased, showing a positive trend countrywide, but it is still very low in certain regions. There is a similar pattern for tetanus coverage, which is 47 per cent nationwide but only 35 per cent in the north and east. Yellow fever immunization has been introduced as a pilot phase in routine EPI in three districts (Koinadugu, Kailahun and Kono). However, improvements in the health delivery system have yet to make significant contributions to morbidity patterns. Malaria, acute respiratory infections, and diarrhoea, and malnutrition account for the majority of consultations at the peripheral health units. The prevalence of low weight and stunting has also not seen any significant change. Similarly, the exceptionally high maternal mortality rate of 1,800 per 100,000 live births gives no impression of diminishing.
Education is one of the government’s highest priorities. The Education and Youth Development programme seeks to contribute to an increase in primary school enrolment and reducing the gender gap. Enrolment levels are increasing year but the gender gap is still widening, indicating that efforts are still needed in this regard. The rehabilitation of schools is also a key priority. About 50 per cent of the primary schools are now functioning, although often in very inadequate conditions. UNICEF assists by provided temporary shelters, desk/bench sets, teaching/learning materials and supporting in-service teacher training. Moreover, the Complementary Rapid Education for Primary Schools (CREPS), a programme is designed to enable the over age children to complete the normally 6 year long primary school programme in not more than three years is operational and growing in several districts.
The Child Protection programme provides co-ordination, strategic direction and financial support various actors working to protect children and their rights. This includes initiatives to ensure that children are provided with the appropriate care and protection through disarmament, demobilisation, emergency care and reunification processes. Since the end of the disarmament, demobilization and reunification (DDR), there has been no child abduction by armed forces. Many of the children who were registered as ‘separated’ within the DDR Programme have been reunited with their families. Consequently, all but three of the interim care centres have closed and the family tracing and reunification scaled down. These have been replaced by a system of community-based reintegration programmes, whereby every reunified child will be supported in their home environment that includes work with the other children in the home community. The girls who were not demobilized and not able to access services, are of major concern. This most vulnerable group requires a unique approach. Work on sexual violence and street children needs to be reactivated.
The Water and Sanitation Programme includes the drilling of boreholes, re-establishing a community based water management systems, and promoting hygienic behaviour.