PIH Sierra Leone

PIH Sierra Leone is on the threshold of a new era. As the team shifts out of the emergency response period necessitated by the 2014-16 Ebola outbreak, there are renewed opportunities to focus on PIH’s core strength – long-term health systems strengthening – with unprecedented momentum. Starting in 2017 with support from the MVC, the team established its mental health program to address critical human resource and mental health infrastructure gaps in the country. They developed a comprehensive strategic plan to help advocate for increased resources and succeed in their role as partners to Government of Sierra Leone in improving the quality, access, and availability of mental health care and public health services in the country. Since then, they have expanded community and clinic-based care in Kono district, and provide ongoing support to the oldest psychiatric hospital in Sub-Saharan Africa, the Sierra Leone Psychiatric Teaching Hospital (SLPTH).

An exciting and remarkable collaboration exists between PIH and the Government of Sierra Leone through which services are strengthened at the SLPTH via infrastructural advancements, capacity building, and systems strengthening. Before support from the MVC, the SLPTH was a deserted tertiary facility without electricity, water supply, and limited medications, leaving patients in chains. After support from the MVC and together with the Ministry of Health, PIH has addressed the most basic hospital needs by establishing 24-7 electricity and running water, renovating patient wards, procuring essential medicines, improving data management systems, psychosocial support and clinical services for areas such as substance use rehabilitation. Through this, it went from an average of 40 to 75 monthly admissions and from 75 to 300 monthly outpatient visits since the start of the program. The improved services have also resulted in an increased number of new patients coming from other chiefdoms, given that SLPTH now offers some of the best services in the country.

A next phase of renovations at SLPTH is currently underway including infrastructure improvements for care delivery, renovating remaining patient wards and grounds, and support for supply chain procurement and laboratory services to improve monitoring of patients on different medications and substances. Clinical services are being expanded for substance use, child and adolescent mental health, occupational therapy, vocational programming, acute support and psychosocial support. The team’s support is transforming SLPTH to be the center of excellence for teaching the next generation of medical professionals and provision of state-of-the-art mental health care services. They are also providing technical, clinical, and operational support to the National Non-Communicable Disease and Mental Health (NCD/MH) Program to establish and expand high-quality, national mental health services.

Given that there is only one psychiatrist in the country, training and program development is a continued priority to address the human resource shortages for specialized mental health services. The government has asked PIH to support the development of a psychiatry residency training program as their flagship initiative to support both specialist and non-specialist mental health training in the country. Conversations with PIH leadership and key stakeholders are underway to explore this opportunity.

Before the MVC, mental health clinics lacked providers, essential medications, and had prohibitive costs making it challenging for people to access services. The Kono team has quickly grown over the past few years by hiring community health workers, psychosocial counselors, and community health officers who work across a continuum of health care. The team leveraged cross-site partnerships with fellow sites to establish successful programs, including learning from PIH Liberia to establish their innovative homeless outreach program. In 2019 the team held a Cross-Site CETA training in Sierra Leone with over 51 participants, and by 2020 they began implementing CETA to decentralize care in the community and create a strong referral system. Building on this, they are integrating mental health services into other key clinical programs and expanding the model from Wellbody to four additional primary care clinics. At the community level, the team has close partnerships with the social mobilization team and acute needs program in order to expand care for the most vulnerable patients. PIH Sierra Leone has strengthened data management systems, and the monitoring and evaluation of mental health services by working with the MOHS to develop data collection tools and M&E systems. They now collect and assess data at tertiary, secondary, primary, and community levels, including the launch of electronic medical records (EMR) at Koidu Government Hospital and Wellbody Clinic.

As a part of their crisis response programming, the PIH Sierra Leone team established a PFA hotline to provide remote psychosocial support, including people directly affected by COVID-19. They also successfully transitioned crucial mental health services to be delivered remotely. Since the start of the pandemic, over 25 stakeholders have been trained in PFA and providers delivered over 700 remote consultations.

Strengthen the capacity to provide high quality mental health care and enhance mental health integration with other health programs such as NCDs, HIV, Tuberculosis, Maternal Health and Adolescent Youth Friendly Mental Health Services
Strengthen and expand the community-based mental health services including supporting staff wellness
Strengthen and expand the psychosocial rehabilitation activities of people recovering from mental illness
Strengthen mental health data management system; monitoring and evaluation; quality improvement and research in mental health
Accompany MOHS to strengthen the National Mental Health Systems at the Sierra Leone Psychiatric Teaching Hospital and through establishing a psychiatry residency

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