2011 Survey of Availability of Modern Contracepves and Essenal Life-Saving Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: ANALYTICAL REPORT AND TABLES

March 2012 UNFPA SIERRA LEONE PREFACE

This is the second annual report of the ‘Survey of Modern Contra ceptives and Essential Lifesaving Maternal and Reproductive Health Medicines in Service Delivery Points’ in Sierra Leone. As part of the reporting system of the Global Programme on Reproductive Health Commodity Security (GPRHCS), it generates time series data on reproduct ive health commodity security including the three country level indicators of: (a) Percentage of Service Delivery Points (SDPs) offering at least three modern contraceptive methods; (b) Percentage of SDPs where five selected lifesaving (including th ree essential) lifesaving maternal/reproductive health medicines are available in all facilities providing delivery services, and (c) Percentage of SDPs with ‘no stock-outs’ of modern contraceptives in the last six months prior to the survey (April-September 2011).

Government of Sierra Leone and UNFPA appreciate the invaluab le contributions of individuals and institutions towards the success of the 2011 su rvey round in Sierra Leone. We are grateful to the Steering Committee of the surveys on rep roductive health commodity security (RHCS). The co-Chairs of the Reproductive Health Division (RHD) and Parliamentary Committee on Health and Sanitation (MoHS) with th eir membership comprising of stakeholders in the health sector are appreciated f or their oversight functions. We also recognize the technical inputs of the Technical Commit tee that is chaired jointly by the Department of Policy, Planning and Information (DPPI) of Mo HS and Statistics Sierra Leone (SSL). The survey would not have been successful without t he willingness of the District Health Medical Teams (DHMTs) to provide the required piece s of information. Many thanks to the RHCS Advisor of UNFPA for managing the exercise a nd to the Principal Investigator and Senior Data for Development Specialist, Mr. Ib rahim Mohamed Sesay, and Research Assistant, Mrs. Cecilia M.S. Sesay, for an excellent technica l and professional job.

There are two volumes to the report: “Volume One – Analytical Report” presents the issues revealed by data analysis and suggests policy options for planni ng and programming of modern contraceptive commodities and services, and provision of essenti al lifesaving maternal/reproductive health medicines. “Volume Two – Tables” i s an inventory of publication tables and other data on the health facilit ies in the country. The information shared in the report will inform the repositioning of family planning and deepening of programming for emergency obstetric care in Sierra Leone. The present ation is technical but highly reader-friendly. We, therefore, recommend this report to all health sector stakeholders, especially policymakers, practitioners in the health se rvice delivery system and civil society.

Ratidzai Ndhlovu (Mrs.) Zainab Hawa Bangura (Mrs.) UNFPA Representative, Minister of Health and Sanitation Republic of Sierra Leone Republic of Sierra Leone

March 2012 i | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT VOLUME ONE: ANALYTICAL REPORT

TABLE OF CONTENT

Content Page Preface ...... i Table of Contents ...... ii List of Tables ...... List of Figures ...... iv List of Abbreviations and Acronyms ...... v Executive Summary ...... vi

PART I: INTRODUCTION ...... 1

1.1 Country Background Information ...... 1 1.2 Rationale and Objectives of the Survey . . . . . 2 1.3 Survey Organization and Management . . . . . 3 1.4 Methodology and Limitations ...... 4 1.4.1 Survey Design and Sampling of Facilities . . . 4 1.4.2 Sampling Frame ...... 5 1.4.3 Use of Sampling Formula to Obtain Sample Size . . 5 1.4.4 Sample Selection ...... 5 1.4.5 Factor to inflate sample size . . . . . 10 1.4.6 Final Step: Systematic Random Sampling of Types of SDPs for Each Administrative Unit . . . . 11 1.4.7 Survey Instrument ...... 12 1.4.8 Data Collection ...... 12 1.4.9 Data Analysis and Presentation . . . . . 12 1.4.10 Limitations of the Survey . . . . . 13 1.5 Outline of Report ...... 13

PART II: SURVEY FINDINGS ...... 15 2.1 General Information about the Facilities . . . . 15 2.1.1 Classification of Health Facilities . . . . 15 2.1.2 Geographic Distribution of Facilities . . . . 16 2.1.3 Management of Facilities . . . . . 18 2.1.4 Distance of SDPs from Source of Supplies . . . 19

2.2 Modern Contraceptives Offered by Facilities . . . . 19 2.2.1 Contraceptives Offered by Type of Facilities . . . 19 2.2.2 Facilities Offering at Least Three Types of Modern Contraceptives 21 2.2.3 Reasons for Not Offering Certain Contraceptives . . 27

2.3 Availability of Maternal and RH Medicines . . . . 28 2.3.1 Maternal and RH Medicines Available by Types of Facili ties . 28 March 2012 ii | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Content Page 2.3.2 Availability of Five Essential Life Saving Maternal an d Reproductive Health Medicines . . . . . 29 2.3.3 Reasons for Not Offering Certain Lifesaving Maternal and Reproductive Health Medicines . . . . . 31

2.4 Incidence of ‘No Stock Outs’ of Modern Contraceptives . . 32 2.4.1 ‘No Stock Out’ at Time of Survey . . . . 32 2.4.2 ‘No Stock Out’ in the Last Six Months . . . . 34 2.4.3 Reasons for ‘Stock Out’ ...... 36

PART III: CONCLUSION ...... 38 3.1 Summary of Findings ...... 38 3.2 Recommendations ...... 38

March 2012 iii | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT LIST OF FIGURES

Figure Content Page

Figure 1: Map Showing Sampled SDPs in the 2011 Survey of Availability xii of Modern Contraceptives and Essential Lifesaving Maternal and Reproductive Health Medicines in Service Delivery Points in Sierra Leone ......

Figure 2: Distribution of SDPs by Rural-Urban Location . . . 18

Figure 3: Percentage Distribution of SDP’s by Type of Management . 18

Figure 4: Percentage Distribution of SDPs by General Availability of Modern Contraceptives ...... 20

Figure 5: Percentage Distribution of SDP’s Offering at Least Three Modern Contraceptive Methods by Rural-Urban Residence . 22

Figure 6: Percentage Distribution of SDP’s Offering at Least Three Modern Contraceptive Methods by Distance from the Nearest Warehouse –within distance analysis . . . . 27

Figure 7: Percentage distribution of SDP’s with Five (including 3 essenti al) Lifesaving Maternal/Reproductive Health Medicines Available by Type of Facility ...... 30

Figure 8: Percentage distribution of SDP’s with Five (including 3 Essentia l) Lifesaving Maternal/Reproductive Health Medicines Available by District ...... 30

Figure 9: Percentage distribution of SDP’s with No Stock outs of Modern Contraceptives in the Last Six Months by Urban and Rural Residence ...... 35

Figure 10: Percentage distribution of SDP’s with No Stock outs of Modern Contraceptives in the Six Months before the Survey by Level of SDP ...... 37

March 2012 iv | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

LIST OF ABBREVIATIONS AND ACRONYMS

CHC Community Health Centre CHO Community health Officer CHP Community Health Post CSB Commodity Security Branch (UN Headquarters) DHMT District Health Management Team DMOs District Medical Officers DPPI Department of Planning, Policy and Information GPRHCS Global Programme to enhance RHCS HIV/AIDS Human Immuno Virus/Acquired Immuno Deficiency Syndrome IUDs Intra Uterine Devices MCH Aides Maternal and Child Health Aides MCHP Maternal and Child Health Post MDGs Millennium Development Coals MoHS Ministry of Health and Sanitation NGO Non-Governmental Organization P.C.M.H Princess Christian Maternity Hospital PHUs Peripheral Health Units RH Reproductive Health RHCS Reproductive Health Commodity Security RHD Reproductive Health Division SDPs Service Delivery Points SECHN State Enrolled Community Health Nurse SPSS Statistical Package for Social Scientists SSL Statistics Sierra Leone TBAs Traditional Birth Attendants UNFPA United Nations Population Fund

March 2012 v | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT EXECUTIVE SUMMARY

Background, Rationale and Methodology of the Survey

Sierra Leone, with a projected current population of about 6.1 million, has about the highest maternal (857/100,000 live births), infant (89/1,000), under-f ive (140/1,000) and child mortality (56/1,000) in the world. About 27 per cent of de aths to women of childbearing ages (15-49) are due to maternal causes, 86 per cent of these occur to women between 15 and 34 years of age and unsafe abortion accounts for 13 per cent o f all maternal deaths. Maternal death rates are high because of limited access to compreh ensive reproductive health services. This is made worse by inadequate access to emergen cy obstetric and neonatal care and family planning services. In 2008, partly a s a result of cultural inhibitions, only 10.2 per cent of all women were reported as using any mod ern method of contraception.

The population exhibits a youthful age structure with 42.1 per cent under 15 years of age. This large youth population sets into motion high growth i nertia over the coming generation even if fertility were to be reduced to a replacement level. Generally, condom use among young people is low at 22.4. Teenage pregnancy is 34 per cent and teenage childbearing contributes to 40 per cent of maternal deaths. By 18 years of age, 69 per cent of young women would have been mothers thus preventing them from continu ing in school. The modern contraceptive prevalence rate of seven per cent, high unmet need for family planning and high school drop-out rates due to teenage an d unwanted pregnancies all contribute to an increasing problem of adolescent fertility an d sexuality with far-reaching social and economic consequences.

Family planning programmes in Sierra Leone are fraught with many problems ranging from inadequate funding, low human resource and infrastructure leve ls, low male involvement and a strong patriarchal social dominance, low female educatio n and social status, among other factors. A key strategy in re-positioning family planning is to ensure the availability and accessibility of family planning commodities (and services) to the po pulation. But reproductive health commodity security is still a challenge due to low capacity in logistic management. The litany of stock-outs of contraceptive commodities and maternal life-saving drugs means that people could not access them when a nd how and where they were desired. Inadequacy of reliable reproductive health commod ity security, therefore, is a major contributor to unwanted pregnancies, unsafe abortions, frequent morbidity and avoidable, untimely deaths.

In 2009, to assist Government of Sierra Leone in the achievemen t of the MDGs and to ensure quality reproductive health and well-being for its pop ulation, UNFPA signed a Memorandum of Understanding with the Government to support repro ductive health commodity security (RHCS) in the country. This survey is part of the reporting system of the Global Programme on Reproductive Health Commodity Security (GPRHCS). It generates time series data on RHCS including the three country level ind icators of:

(a) Percentage of Service Delivery Points (SDPs) offering at least three modern contraceptive methods; March 2012 vi | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

(b) Percentage of SDPs where five selected lifesaving (including th ree essential) lifesaving maternal/reproductive health medicines are available in all facilities providing delivery services, and (c) Percentage of SDPs with ‘no stock-outs’ of modern contraceptives in the last six months prior to the survey (April-September 2011).

The survey was commissioned, therefore, to collect information to sa tisfy data needs and to generate these indices to facilitate international comparabi lity of the collected data and cross cultural analysis that would enhance the repositioning of family planning in efforts at meeting the health MDGs in Sierra Leone. The information sh ared in the survey reports will inform the repositioning of family planning and deepening of programming for emergency obstetric care in Sierra Leone.

The methodology used the types of service delivery points (SDPs – pri mary, secondary and tertiary or equivalent) as the main attributes and the total sample was chosen such as to contain a minimal number of each type of facility to support a good estimation of the parameters of the population. To allow for data comparisons between and among populations, the sample estimation was based on a formula th at assumed normality of the distribution of the attributes. Built into the formula is the tendency of according a higher probability of inclusion of secondary and tertiary level SDPs in t he survey because of their small number in the sample frame. Abnormal oversized sample sizes were adjusted and a systematic subsampling with a random start was employed, based on p robability proportional to size, to draw the final selection of the u nits of analysis.

Key Findings

The health service delivery system in Sierra Leone operates at three levels – primary, secondary and tertiary. Primary healthcare is the hub of the hea lth system and accounts for about 70 per cent of all health facilities in the country . It is made up of the maternal and child health posts (35 per cent), child health posts (11 per cent) and community health posts (24 per cent), in order of increasing responsibility. Cases that can not be dealt with at the highest level of the primary healthcare units are referred to the seconda ry (28 per cent of the facilities) and tertiary levels for treatment. The tertiary level SDPs (2 per cent) are top level referral health units which also function as Teaching Hospita ls.

The 2011 survey shows that there are considerable variations in ru ral-urban residence patterns and among the districts with respect to the distributi on of health centres. The rural areas have 61.3 per cent of the health facilities and abou t a similar proportion of the population. This is unlike in 2010 when 52.7 percent of the health facilities in the sample came from the urban areas with less than 40 per cent of the po pulation. In addition, the distribution by district ranges from 3.7 per cent in Pujehun Dist rict to 20.6 in the Western Area. Also, 35 per cent of the districts are home to 57 per cent of the SDPs.

March 2012 vii | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

About 70 per cent of the health centres are managed by the Government, down by five per cent the 2010 level. Each government health centre is supervised by a District Health Management Team (DHMT) that plans, implements, coordinates, monit ors and evaluates the district health services under the leadership of a District Me dical Officer (DMO). The Medical Officer in-charge-of the district hospital works with ex-off icio members of various programs, projects and units as part of the DHMT. The private health facilities are supervised by their individual owners and/or Boards of Directors. T hey are found mainly in urban localities where they get patronage from members of highe r socio-economic households.

A fifth of the SDPs are located within a mile of the warehouses that supply them but 53 per cent of the facilities are located beyond 20 miles of the w arehouses. Compared with 38.3 per cent of the 2010 samples, the 2011 samples seem to be much further located from their warehouses.

About 82 per cent of the health centres provide family plann ing services and commodities. The most popular modern contraceptives are male condoms, oral pills and injectables which are found in 80 per cent of the SDPs. A salient feature of the 2011 data is the prominence of female condoms (about 70 per cent) in the contraceptive mix at the health facilities. Except for IUDs and male sterilisation, SDPs were putting more of each kind of contraceptive on offer in 2011 than in 2010 and this improve d service delivery is marked mainly at the primary level of healthcare. Female and male ste rilization, IUDs and implants are still the least popular forms of modern contraception but i n response to the poor state of availability of modern contraceptives in government hospitals in 2010, significant steps were taken in 2011 to correct the situation.

In 2011, 80.5 per cent (281 out of 349) of the health f acilities offered at least three modern contraceptive methods. This represents a drop of 6.7 per cent from the 2010 level of 87.2 per cent. The spread by type of SDP is 90.2 per cent for primary, 58.2 per cent for secondary and 50.0 per cent for tertiary health facilities. More over, the rural-urban distribution of facilities offering at least three types of modern contraception reveals that 91.1 per cent of rural SDPs are served as against 63.7 per cent of urban SDPs. All SDPs in Koinadugu, Bonthe and Pujehun Districts have three or more modern contraceptives. In addition, Kambia and Kailahun Districts have reasonably high l evels of availability of contraceptives.

Government health centres are the most important source of contracep tives with about 92 per cent of them offering at least three types of contraception. Private clinics and hospital do not normally put contraceptives on offer because UNFPA, the largest provider of contraceptives, insist on free delivery of commodities and services. T he faith-based organisations also do not provide the commodities and services beca use of religious reasons.

March 2012 viii | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Distance from the warehouse of regular supplies does not seem to have a drawback effect on efforts at providing contraceptives nationwide. Long term contraceptives like IUD, implant and sterilization (male and female) may not be on off er at a health centre because of lack of trained personnel. Low client demands because of a phobia for the side effects of the long acting contraceptives and unwillingness to pay are a lso some of the reasons for non-availability of these contraceptives.

In 2011, 84.5 per cent of the health facilities were off ering maternal and reproductive health medicines to the population. This represented a reduction of 10 per cent in comparison with the 2010 level. While the health centres had various lifesa ving medicines, no particular lifesaving medicine was available in all of these health ce ntres. Iron/folate is the most popular and is available at about 78 per cent of the faci lities. Magnesium sulphate, metronidazole and oxytocine are available for between 61-69 p er cent of the health facilities. The poorest availability of these drugs relate to azithromycin (1 5.5 per cent) and cefexime (9.7 per cent). CHCs and MCHPs account for about 60 per cent of all the available drugs captured in the 2011 survey. But for azithromycin and iron/fola te, the level of availability in 2010 was higher than in 2011 for all types of drugs.

The percentage of SDPs where five selected (including three essen tial) lifesaving maternal/reproductive health medicines are available in all fa cilities providing delivery services is 91.2; 80.4 per cent for urban and 96.5 per cent for rural areas. This is the case for two-thirds of the tertiary, three-quarters of the secondary and 96 per cent of the primary SDPs. The distribution by district shows the biggest variations a s it ranges from 40 per cent in Moyamba and Kambia Districts to 100 per cent in Port Loko Distri ct.

As with the analysis on contraceptive availability, distance d oes not seem to have a decisive effect on drug availability. The highest levels of non-ava ilability of the medicines can be found among SDPs located very near to (between 5-19 miles radius) a nd mid-range (25-29 and 35-39 miles radius) from the warehouses. In between these distances are considerable variations but, generally, the proportion offering five (incl uding three essential) maternal or reproductive health medicines increases with distance from the ware house of usual supply. These findings are similar to the ones on availability of th ree modern contraceptive methods above and show that distance did not have a meaningful fri ctional effect on the supply of maternal/reproductive health medicines.

In 2010, there were two main reasons why some life-saving materna l and reproductive health medicines were not offered at the SDPs – stock-out and t hat the medicine was not on offer at the health facility. In 2011, the only main reason for unavailability of these medicines was lack of supply. With the exception of magnesium sulphate and iron/folate, the rest of the medicines were not offered at most of the SDPs. The drugs with the highest levels of neglect are amoxicillin, benzathine penicillin, cefexime and azithromycin. Other less important reasons for not offering the drugs include patients preferring to buy their drugs from outside the health facility, the medical doctor preferrin g an alternative drug, expensiveness of the medicine, low client demand and fear of side effects.

March 2012 ix | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Male and female condoms, oral pills and injectables (in order o f importance) were generally available at the time of the survey. Sterilization for males and females were the most unpopular brands of contraceptives in stock. Their absence at th e CHCs and CHPs may be connected with the lack of trained personnel to handle the task at those levels. All kinds of commodities were offered at the urban centres. Even in the rural areas, commodities were fairly available except that female and male sterilization we re absent at all the rural health facilities.

Nationwide, only 35.42 per cent of the SDPs experienced ‘no stock-outs’ in the six months preceding the 2011 survey. In comparison with the 2010 figu re of 41.35 per cent, an average of six more out of every 100 health facilities in 2011 experienced stock outs. In the six months preceding the survey, the percentage of no stock outs i n the rural areas was 35.5 and that for the urban centres was 31.3. The level of no stock out for primary, secondary and tertiary level facilities was 35.2, 30.7 and 29.2 respect ively.

Oral pills, injectables and male and female sterilization we re virtually in stock outs in the six months before the survey. The low level of presence of these four types of modern contraceptives in both the rural and urban areas goes beyond mere lack of requisite personnel to administer the services. The reasons may include fear of side effects due to low level of sensitization to create demand and cultural resist ance to family planning generally. Though the availability situation of the MCH Ps and CHCs is much better than other SDPs, the general pattern of provision of the contracepti ves is similar across SDPs. Five main reasons were given by the respondents for stock outs: (a) p roblems with the distribution system, (b) out of stock because of lack of supply, (c) no clients (patients do not come for it for fear of side effects), (d) no skilled staff and (e) people do not want to pay for contraceptives. Recommendations

The issues revealed by data analysis form the basis of recommendatio ns for policy options for planning and programming of modern contraceptive commodities a nd services, and provision of essential lifesaving maternal/reproductive health me dicines. The recommendations will inform the repositioning of family planni ng and deepening of programming for emergency obstetric care in Sierra Leone. The recommend ations are:

(a) Government of Sierra Leone should continue to deepen famil y planning services by maintaining it as an integrated part of primary healthcare. This requires the enforcement of the primary healthcare policy even in health cent res owned by non-governmental and faith-based organizations and private-for-pro fit institutions. Efforts should also be made to encourage the management of th ese health facilities that are not run by Government to accommodate family p lanning as part of their services with user fees either removed or kept at cost-recovery l evels. To fill the gap left by the withdrawal profit-making health facilities from the free delivery of contraceptives, alternative outlets and outreach service s need to be sought to ensure that the situation does not deteriorate a ny further;

March 2012 x | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

(b) The report is replete with gross inadequacies of human resource s for the delivery of long-term contraceptive methods to the population. In th e short term, there is need to train a core group of health service personnel to start the delivery process. In the medium term, it is necessary to include this as a module i n the training of health service personnel at the intermediate level;

(c) More efforts at demand creation are needed to increase contracep tive uptake especially in communities in poor road network environments. Famil y planning can be used as an entry point into community development initi atives. This should involve community sensitization and male involvement to weaken cul tural stereotypes currently inhibiting family planning practices;

(d) Operations researches on the contraceptive prevalence are necessary t o inform the current repositioning of family planning in the country. A baseline, midterm and end line surveys will provide the opportunity for benchmarkin g and constantly monitoring progress in family planning interventions, and

(e) The logistic management system should be further strengthened to minimize stock outs especially of lifesaving maternal/reproductive health me dicines. The situation of ineffective supplies of cefexime, azithromycin, metro nidazole, amoxicillin and benzathine penicillin needs special investiga tion to know why the drugs are frequently out of stock. A more robust and effective monitoring of the situation is also recommended for efficient forecasting and supp ly chain management of the drugs and contraceptives.

March 2012 xi | Page FIGURE 1: SAMPLED SDPs IN THE 2011 SURVEY OF AVAILABILITY OF MODERN CONTRACEPTIVES AND ESSENTIAL LIFESAVING MATERNAL AND REPRODUCTIVE HEALTH MEDICINES IN SERVICE DELIVERY POINTS IN SIERRA LEONE N W E S

Sampled SDPs Chiefdom Boundary District Bo Bombali Bonthe Kailahun Kambia Kenema Koinadugu Kono Moyamba Port Loko Pujehun Tonkolili Western Area Rural Western Area Urban

60 0 60 120 Kilometers UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

PART I: INTRODUCTION

1.1 Country Background Information

Sierra Leone, with a projected current population of about 6.1 million, has about the highest maternal, infant, under-five and child mortality 1 in the world. The Sierra Leone Demographic and Health Survey (2008) reported that 27 per cent of deaths t o women of childbearing ages (15-49) is due to maternal causes and 86 per cent of maternal de aths occurred to women between 15 and 34 years of age. Though maternal mortality peaks in the 30-34 age group, it is very high for the youngest women (15-19 years of age). The tragedy – and opportunity – is that most of these maternal deaths are avoidable if cost-e ffective healthcare services can be provided 2.

Maternal death rates are high because of limited access to compreh ensive reproductive health services to tackle major clinical problems like anaemia, obst ructed labour, infections, abortion and eclampsia. Unsafe abortion accounts for 13 per ce nt of all maternal deaths. This is made worse by inadequate access to emergency obstetric and n eonatal care and family planning services. For example, in 2008, partly as a resul t of cultural inhibitions, only 10.2 per cent of all women were reported as using any modern me thod of contraception 3. Generally, condom use among young people is low with 22.4 and 12.2 per cent for males and females aged 15-24 respectively. HIV prevalence among young people is about 1.2 per cent with young females contributing 57 per cent.

The population exhibits a youthful age structure with 42.1 per cent under 15 years of age, 19.3 per cent aged 15-24 years, 17.5 per cent aged 25-34 years and just four per cent is older than 64 years (census 2004). The amount of youths in the population sets into motion high growth inertia over the coming generation even if ferti lity were to be reduced to replacement level. The prevalence of teenage pregnancy is 34 per cent and teenage childbearing contributes to 40 per cent of maternal deaths. By 18 years of age, 69 per cent of young women would have been mothers thus preventing them f rom continuing in school.

The population is entrapped in a web of entrenched socio-cu ltural stereotypes that favour large family sizes and early and universal marriages 4. The modern contraceptive prevalence rate of seven per cent 5, high unmet need for family planning 6 and high school drop-out rates due to teenage and unwanted pregnancies all contribute to an increasing

1 There are 857 maternal deaths per 100,000 live birth s and out of each 1,000 live births, there are 89 infan t, 140 under-five and 56 child deaths (Sierra Leone DHS 2008). 2 UNFPA Sierra Leone (August 2011) – ‘Population, Rep roductive Health, HIV/AIDS and Gender (PRHG) Analysis’, UNFPA, Freetown, Sierra Leone; p.16. 3 Ib.id. 4 Over 90 percent of persons more than 20 years of age have ever be en married. 5 DHS 2008. Also, only 10.2 percent of all women were r eported as using any modern method of contraception. 6 Until recently, service delivery points (SDPs) in the country suffere d from frequent ‘stock-outs’ of reproductive and child health commodities. March 2012 1 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT problem of adolescent fertility and sexuality with far-reaching social and economic consequences 7.

These socio-cultural barriers such as spousal disapproval for family pla nning and preferences for large family sizes are an impediment to contraceptive use. Though the contraceptive prevalence rate has improved slightly from about 3 pe r cent in 2002 to 7 per cent in 2008, it is still low. Unmet need for family plann ing services remains high at 28 per cent. About 48 per cent of health facilities offering at least three modern contraceptive methods are in urban areas where only 37 per cent of the peop le lives.

In general, family planning programmes in Sierra Leone are fraug ht with many problems ranging from inadequate funding, low human resource and inf rastructure levels, low male involvement and a strong patriarchal social dominance, low femal e education and social status, among other factors. For the programme to be re-positione d, these major constrains would have to be dealt with. Issues of knowledge, attit udes and practices of family planning would have to be mainstreamed into all health programmes and more resources provided (financial, human, material, logistical, etc.) for it to be re -launched on a higher platform and incorporated into other development projects and programmes.

A key strategy in re-positioning family planning is to ensure th e availability and accessibility of family planning commodities (and services) to the population. But reproductive health commodity security is still a challenge due to low capacity in lo gistic management. The capacity to plan, forecast and manage the logistic chain was ve ry low until quite recently. The litany of stock-outs of contraceptive commodities and maternal life-saving drugs means that people could not access them when and how they were de sired. Inadequacy of reliable reproductive health commodity security, therefore, is a major contrib utor to unwanted pregnancies, unsafe abortions, frequent morbidity and avoidabl e, untimely deaths.

The second MDG progress report (2010) for Sierra Leone acknowledges t hat the only MDG goal towards which satisfactory efforts have been made is the HI V/AIDS component (Goal 6) while reduction in malaria and tuberculosis will lag behi nd. Goals 4 and 5 (child and maternal mortality respectively) may only be met with sustained effo rts8 in improving general healthcare services through increased funding to the sector and ma king the services accessible and affordable to the broad mass of the populatio n.

1.2 Rationale and Objectives of the Survey

In ensuring reproductive health and well-being of its popul ation, in 2009, Government of Sierra Leone signed a Memorandum of Understanding with UNFPA for a five year support to reproductive health commodity security (RHCS) in Sierra Leone. In 2010, a RHCS

7 See, for example, Government of Sierra Leone and UNFPA (Febr uary 2011) – Survey of Availability of Modern Contraceptives and Essential Life-Saving Maternal and Reproductive Health Medicines in Service Delivery Points in Sierra Leone, GoSL/UNFPA, Freetown, Sierra Leone; p.1 8 Government of the Republic of Sierra Leone (2010) – Millenni um Development Goals Progress Report 2010, Government of Sierra Leone, Freetown, Sierra Leone; p.11. March 2012 2 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT in Sierra Leone. In 2010, a RHCS survey 9 was done as part of UNFPA global programme on RHCS technical and financial support to government to ensu re that all individuals can obtain and use affordable, quality reproductive health commod ities whenever they need them. As Sierra Leone is part of 12 Stream One Countries worldw ide benefiting from this initiative10, the survey was undertaken to provide benchmark information which is essential for sound RHCS planning and for making administrative and pol icy decisions about the same. The information is desirable for implementation and co-o rdination of family planning programming by helping to fill a critical dearth of reliable, high quality and timely data for programme monitoring and evaluation. The programme of Reproduct ive Health Commodity Security (RHCS) ensures that there are no “stock-outs” of reproductive and child health (RCH) commodities in all service delivery points (SDPs) in the country.

Stream One Countries have been reporting the availability of contraceptives and essential reproductive health medicines through the GPRHCS performance monit oring country questionnaire since the inception of the Global Programme on RHCS (GPRHCS). Although these past country reports provided the basis for aggregating rele vant regional and global level indicators, there has always been a compelling need to conduct annual surveys that would generate the following three country level outcome in dicators:

(a) Percentage of SDPs with at least three (3) modern methods of con traceptives, (b) Percentage of SDPs where five (5) life-saving maternal/reproductive health medicines from UNFPA list are available in all facilities provi ding delivery services and (c) Percentage of SDPs with ‘no stock outs’ of contraceptives within the last six months before the survey.

The survey was commissioned, therefore, to collect information to sa tisfy these data needs and to generate these indices to facilitate international comparability of the collected data and cross cultural analysis that would enhance the repositionin g of family planning in efforts at meeting the health MDGs in Sierra Leone.

1.3 Survey Organization and Management

The organization and management of the 2011 Global Programme on Reproductive Health Commodity Security (GPRHCS) Survey was done through the standing Steeri ng Committee that was established by the Ministry of Health and Sanitatio n (MoHS) to oversee the 2010 GPRHCS Survey. The survey benefited from the excellent collaborat ion between the Ministry of Health and Sanitation (MoHS), UNFPA and health se ctor stakeholders. The Reproductive Health Division (RHD) of MoHS and the Parliamentary Committee on Health and Sanitation as Joint Chairs provided administrative guidance . The Technical Committee

9 “Survey of Availability of Modern Contraceptives and Essential Lif e-Saving Maternal and Reproductive Health Medicines in Service Delivery Points in Sierra Leone”. 10 The other eleven countries are Burkina Faso, Laos PDR, M ongolia, Niger, Ethiopia, Madagascar, Mozambique, Hait i, Mali, Nicaragua and Nigeria. March 2012 3 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT co-chaired by the Department of Planning, Policy and Information (DPPI) of MoHS and Statistics Sierra Leone (SSL) contributed some technical expertise at va rious stages of the conduct of the survey. The management of the survey project was done by the RHCS Advisor of UNFPA.

The Senior Data for Development Specialist (SDDS) of UNFPA was t he lead investigator and was responsible for all technical procedures from survey inceptio n to report writing. A Research Assistant and three Field Supervisors assisted the field w ork. The Research Assistant supervised the Field Supervisors who in turn supervised the Enumerators. The country was divided into four supervisory zones as follows:

(a) ZONE ONE: Western Rural and Urban Areas; (b) ZONE TWO: Port Loko, Kambia, Bombali, Tonkolili and Koinadu gu Districts; (c) ZONE THREE: Bo, Bonthe, Moyamba, and Pujehun Districts, and (d) ZONE FOUR: Kenema, Kono and Kailahun Districts.

Each Field Supervisor was in-charge of the Enumerators in each of Zo nes Two, Three and Four. The Enumerators in the Western Area were supervised by the SDDS. The Research Assistant coordinated the enumeration in the Northern Province a nd Kono District whilst the rest of the country was coordinated by the SDDS.

1.4 Methodology and Limitations

1.4.1 Survey Design and Sampling of Facilities

Initially, assessment of the implementation of the GPRHCS wa s done through indicators outlined in the Monitoring and Evaluation Framework according to which three outcome indicators were used to obtain data for the following coun try level indicators:

(a) Percentage of SDPs offering at least three modern methods of co ntraceptives; (b) Percentage of SDPs where five life-saving maternal/reproductive he alth medicines from UNFPA list is available in all facilities provid ing delivery services, and (c) Percentage of SDPs with ‘no stock-outs’ of contraceptives in the si x months preceding the survey (April to September 2011).

The following broad categories of SDPs that provide modern meth ods of contraceptives and maternal/reproductive health services were considered as strata:

a) Primary level care SDPs/facilities 11 (or equivalent to the country context); b) Secondary level care SDPs/facilities/hospitals (or equivalent), and c) Tertiary level care SDPs/facilities/hospitals (or equivalent).

A simple, single round design was employed using a representati ve sample proportional to the size of each stratum and drawn from all districts and provinces of the country.

11 In accordance with the Ministry of Health and Sanitation’s ca tegorization, the primary level care facilities were furt her subdivided into Community Health Centre (CHC), Community Healt h Post (CHP) and Maternal and Child Health Post (MCHP). March 2012 4 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Both the distribution of these SDPs in the administrative unit s of the country and the type of services they provide (some may provide one and others both - modern met hods of contraceptives and maternal/reproductive health services) were relevant to the study. This was a standardized framework provided by the Commodity Security Branch (C SB) of UNFPA for all the GPRHCS Stream One Countries for the conduct of the survey.

1.4.2 Sampling Frame

The list of all SDPs that offer family planning and maternal health services in the country was provided by the Department of Policy, Planning and Informa tion (DPPI) of MoHS. This list was an updated version of the frame population of the 2010 RHCS survey and it was used in the selection of samples per administrative subdivision o f the country.

1.4.3 Use of Sampling Formula to Obtain Sample Size

The types of the SDPs (primary, secondary and tertiary or equivalent) were taken as the main attributes and the total sample was chosen such as to cont ain a minimal number of each type of facility to support a good estimation of the p arameters of the population using the following formula:

Z2 p (1 - p) n = d2 Where n = minimal sample size for each domain Z = Z score that corresponds to a confidence interval p = the proportion of the attribute (type of SDP) expressed in decimal d = percent confidence level in decimal

This formulation was used because facility based surveys often take into consideration the categories of health SDPs, which may vary from country to country, in the selection of an appropriate sample size. In some instances, facility data are li nked with data on clients and service providers which affect the sample size and the manner in wh ich it is chosen. This study focused on the type of facilities as ‘standalones’ and, therefore, no data were collected on staff, clients or the population. The formula estimated the minimal sample size for the proportions of each category of SDPs under the assumptions of normal distribution, thus enabling data comparisons between and among populations.

1.4.4 Sample Selection

Built into the formula is the tendency of according a higher probability of inclusion of secondary and tertiary level SDPs in the survey because of their small number in the sample frame. The subnational distribution of the service delivery po ints (SDPs) are as in Table 1.

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Table 1: Types of Service Delivery Points Providing Modern Methods of Contraception in Sierra Leone by Administrative Unit Types of Service Delivery Points/facilities/ hospitals Administrative Unit: (or equivalent) Province and Tertiary Level Secondary Level Primary Level District Total Care Care Care EASTERN Kailahun 0 3 78 81 Kenema 1 11 112 124 Kono 0 2 82 84 NORTHERN Bombali 1 10 95 106 Kambia 0 5 60 65 Koinadugu 0 4 67 71 Port Loko 0 9 108 117 Tonkolili 0 5 89 94 SOUTHERN Bo 1 24 108 133 Bonthe 0 6 51 57 Moyamba 0 7 92 99 Pujehun 0 2 63 65 WESTERN Rural 0 10 38 48 Urban 2 64 42 108 TOTAL 5 162 1,085 1,252

1.4.4.1 Steps for Sampling SDPs for the GPRHCS Survey

1.4.4.1.1 Calculation of Relative Proportion for the Types of SDPs

The relative proportion for tertiary level SDPs was calculated as f ollows: [Total number of tertiary SPDs] ÷ [Total number of SDPs in the sample frame].

From the information in Table 1, this is 5 ÷ 1,252 = 0.004. The procedure was repeated for secondary and tertiary institutions and the results presented in Table 2.

Table 2: Relative Proportion of Categories of SDPs in Sierra L eone

Types of Service Delivery Points/facilities/ hospitals (or equivalent) Parameter Tertiary Level Secondary Level Primary Level Total Care Care Care Number of SDPs 5 162 1,085 1,252 Relative Proportion 0.004 0.1294 0.8666 1.0000

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1.4.4.1.2 Application of the formula above to obtain the minimal sample size for each Type of SDP

By proposing the use of a confidence interval, the formula provi des a range of values where a given true population parameter is likely to be. The rang e of values is also determined by the confidence limit or the precision of the estimated value. The confidence interval was set at Z-score = 95 per cent and five (5) per cent confidence limit ba sed on the recommendation.

Thus, the minimum sample size for tertiary level care SDPs/facilities/h ospitals (or equivalent) at the 95% confidence interval and 5% confiden ce limit is as follows: Z 2 p (1 - p) (1.96) 2 x (0.004) (0.996) n = n = d2 (0.05)2

3.8416 x .004 n = n = 6.15 0.0025

Also, the minimum sample size for secondary level care SDPs/facilities/h ospitals (or equivalent) at the 95% confidence interval and 5% confiden ce limit is as follows: Z 2 p (1 - p) (1.96) 2 x (0.1294) (0.8706) n = n = d2 (0.05)2

n = 3.8416 x 0.1127 n = 173.18 0.0025

Moreover, the minimum sample size for primary level care SDPs/facilities/h ospitals (or equivalent) at the 95% confidence interval and 5% confiden ce limit is as follows:

Z 2 p (1 - p) (1.96) 2 x (0.8666) (0.1334) n = n = 2 2 d (0.05)

n = 3.8416 x 0.1156 n = 177.64 0.0025

These are shown against the respective population sizes in each stratum in Table 3 below.

1.4.4.1.3 Correction for Abnormal-oversized Samples

Also in Table 3, the application of the estimating formul a resulted in the minimal sample sizes obtained for tertiary and secondary levels of SDPs being great er than the number of SDPs. To correct these abnormal oversized samples, the whole popula tion of the category under consideration was included in the sample. This abnormal ity occurred because the sizes of the strata populations were too small for the assumptio ns of normal distribution of the frame population to prevail using the 95 per cent confi dence

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Table 3: Minimal Sample Sizes for Sierra Leone Based on 95 Per Ce nt Confidence Interval (Z-score = 1.96) and 5 Per cent Confidence Limit against Number of SDPs per Stratum Types of Service Delivery Points/facilities/ hospitals (or equivalent) Parameter Tertiary Level Secondary Level Primary Level Total Care Care Care Minimum sample size based on 95% confidence interval (Z = 1.96) and 5% confidence limit (d = 0.05) 6 173 178 357 Number of SDPs 5 162 1,085 1,252

The abnormal sample sizes were, therefore, corrected by replacing th e oversized samples by the population sizes shown in Table 4. The total sampl e size for all categories was also recalculated to reflect this correction.

This means that for Sierra Leone:

• All the 5 tertiary level care SDPs/facilities/hospitals (or equi valent) were included in the sample; • All the 162 secondary level care SDPs/facilities/hospitals (or eq uivalent) were included in the sample, and • 178 of the 1,085 primary level care SDPs/facilities (or equivale nt to country context) were included in the sample. Thus, a total of 357 (28.5 per cent) SDPs were to be sampled from the population of 1,252 SDPs nationwide.

Table 4: Corrected Minimal Sample Sizes for Sierra Leone Based on the 95 Per cent Confidence Interval and 5 Per Cent Confidence Limit

Types of Service Delivery Points/facilities/ hospitals (or equivalent) Parameter Tertiary Level Secondary Level Primary Level Total Care Care Care Minimum sample size based on 95% confidence interval (Z = 1.96) and 5% confidence limit (d = 0.05) 5 162 178 345

1.4.4.1.4 Distribution of Sample Sizes for Administrative Units

Using probability proportional to size (pps), the total sample size for each category of SDPs was distributed among the administrative units according to the ir share of a particular category of SDP (Table 5). This required the calculation of t he relative proportions for each March 2012 8 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

domain. For example, the proportion of secondary level healt h facilities in Port Loko District = Number of tertiary level care SDPs/facilities/hospitals (or equivale nt) in Port Loko District ÷ Total of tertiary level care SDPs/facilities/hospitals (or equiva lent) = 9 ÷ 162 = 0.06. (This indicates that 6.00 per cent of all ‘Secondary level care SDPs/fa cilities/hospitals (or equivalent)’ is located in Port Loko District).

Table 5: Proportion of Categories of Service Delivery Points by Ad ministrative Unit

Administrative Unit: Types of SDPs/facilities/ hospitals (or equivalent) Province and Tertiary Level Secondary Level Primary Level District Total Care Care Care EASTERN Kailahun 0.00 0.02 0.07 0.06 Kenema 0.20 0.07 0.10 0.10 Kono 0.00 0.01 0.08 0.07 NORTHERN Bombali 0.20 0.06 0.09 0.08 Kambia 0.00 0.03 0.06 0.05 Koinadugu 0.00 0.02 0.06 0.06 Port Loko 0.00 0.06 0.10 0.09 Tonkolili 0.00 0.03 0.08 0.08 SOUTHERN Bo 0.20 0.15 0.10 0.11 Bonthe 0.00 0.04 0.05 0.04 Moyamba 0.00 0.04 0.08 0.08 Pujehun 0.00 0.01 0.06 0.05 WESTERN Rural 0.00 0.06 0.03 0.04 Urban 0.40 0.40 0.04 0.09 TOTAL 1.00 1.00 1.00 1.00

1.4.4.1.5 Distribution of Sample Sizes for Administrative Units

The relative proportions in Table 5 were applied to the mi nimal sample sizes of each type of SDP indicated in Table 4 to distribute the samples for each category of SDP among the various districts. The results are presented in Table 6 under a Z-score for 95 per cent confidence interval and 5 per cent confidence limit. The ou tcome of the procedure means that all the tertiary and secondary levels of SDPs/ facilities/ho spitals (or equivalent) should be included in the sample and surveyed. Likewise, 18 of the 178 Primary Level SDPs, etc. (or equivalent to country context) in Bo District should be systemati cally selected; and another 11 of them in Pujehun District should be systematically selected and included in the sample of SDPs.

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Table 6: Distribution of Minimal Sample Sizes for Each Category o f SDP in Sierra Leone Z(95% 0.05)

Administrative Unit: Types of SDPs/facilities/ hospitals (or equivalent) Province and Tertiary Level Secondary Level Primary Level District Total Care Care Care EASTERN Kailahun 0 3 12 15 Kenema 1 11 18 30 Kono 0 2 14 16 NORTHERN Bombali 1 10 16 27 Kambia 0 5 11 16 Koinadugu 0 3 11 14 Port Loko 0 10 18 28 Tonkolili 0 5 14 19 SOUTHERN Bo 1 24 18 43 Bonthe 0 7 9 16 Moyamba 0 7 14 21 Pujehun 0 2 11 13 WESTERN Rural 0 10 5 21 Urban 2 65 7 74 TOTAL 5 164 178 353

1.4.5 Factor to Inflate Sample Size

Unlike the 2010 Survey of Availability of Modern Contraceptives and Essential Life-Saving Maternal and Reproductive Health Medicines in Service Delivery Poin ts in Sierra Leone for which a 10 per cent inflation factor was used to compensate f or possible non-response or non-existence of SDPs 12, the current exercise did not attempt it. The sample size of 352 (about 28.1 per cent) was already large enough to be represent ative. However, in cases of sample decay arising out of such nonresponses, Enumerators were given replacement SDPs based on the intrinsic skip order established using a random st art and the sampling fraction for each domain in the respective district.

12 In 2010, the overall sample size of 108 SDPs was 8.65 per cent .

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1.4.6 Final Step: Systematic Random Sampling of Types of SDPS for Each Administrative Unit The units of observation were chosen from the population of SDPs for each domain in the population as follows: 1. The facilities were listed in alphabetical order and no t with regards to any characteristic; 2. A Sampling Interval (i) was determined for the primary level do main for which sampling was required. This was done for each district by dividi ng the total number of facilities by the sample size: i = N / n Where: i = sampling interval for the domain, N = number of SDPs in the district and n = district sample size; This procedure is demonstrated in Table 7. Table 7: Sampling Intervals for the Respective Geographic Subdi visions of Sierra Leone Z(95% 0.05)

Province/District Sample (n) Population (N) i = N/n EASTERN Kailahun 12 81 7 Kenema 18 124 7 Kono 14 84 6 NORTHERN Bombali 16 106 7 Kambia 11 65 6 Koinadugu 11 71 7 Port Loko 18 117 7 Tonkolili 14 94 7 SOUTHERN Bo 18 133 7 Bonthe 9 57 6 Moyamba 14 99 7 Pujehun 11 65 6 WESTERN Rural 5 48 10 Urban 7 108 15 TOTAL 178 1252 7

3. A starting point (K) was determined by randomly selecting a nu mber between 1 and i (the sample interval). K was the first SPD in the domain to be chosen; 4. Successive SDPs were selected for inclusion in the sample by moving at the interval K+i; K+2i; K+3i; K+4i; K+5i; etc., until the required sample size from the domain was chosen. March 2012 11 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

1.4.7 Survey Instrument

The survey instrument received from Commodity Security Branch (CSB) is a semi-structured questionnaire of tabular schedule that is divided into five sections. Schedule one is on the location and distance of the SDPs. Sch edule two has information on the type of SDP and services provided. Schedule three deals with information on modern contraceptive methods provided at the SDP. Schedule four is on availability of maternal and reproductive health medicines. The last schedule investigates whether stocks of contraceptives are available at the time of the survey and d uration of stock-outs at an SDP. Stocks are physically verified in schedules three to five by th e interviewers to ascertain their availability or otherwise at the time of the interview. If stocks are not available, the main reason for the stock-out is recorded.

In response to a request from Ministry of Health and Sanitation .(MoHS) of Sierra Leone, a Tracer Drugs Module was added to the parent questionnaire. T he module solicited information on the basic minimum ranges of drugs and vaccines that should exist at a service delivery point for it to qualify as a health facility. All drugs and vaccines investigated were verified by Enumerators as seen in stock at the time of intervi ew. The analysis of the information in the Tracer Drugs Module was done separately for t he attention of authorities at the MoHS.

1.4.8 Data Collection

Field data collection was done during 15th to 26th Octob er 2010. As in Section 1.3, the field staff was divided into four. In accordance with the catego rization of healthcare facilities by the MoHS and given the importance of primary level SDPs in the cou ntry (Section 2.1.1), data collection was disaggregated for this level of caregivers i nto Community Health Clinics (CHC), Community Health Posts (CHP) and Maternal and Child Healt h Posts (MCHP).

Because of the high quality of data collected in the 2010 round survey, the Steering Committee endorsed the recruitment of those enumerators who were available and willing to participate in the 2011 round of survey. Some new enumera tors were also recruited because the sample size for 2011 was much larger than in the pre vious year. In order to ensure a smooth fieldwork, training took on-board 10 per cent mo re enumerators than necessary. In the event of attrition, the best of the reserve enumerators would be brought into action to complete the task.

1.4.9 Data Analysis and Presentation

After the field data collection exercise, the Supervisors checked a ll the questionnaires administered in their areas of responsibility. Two Coders code d the open-ended questions. After orientation of the data entry clerks, data entry and some editing were done in Microsoft EXCEL. The partially cleaned data were exported to SPSS for furth er editing and analysis.

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In the SPSS Variable View facility, some of the variable labe ls that were not properly defined were corrected. Preliminary frequencies and percentage distribution s for all variables were run and checked to determine their accuracy and acceptability using the Data View facility. The final tables were produced either directly through the SPSS analysis command or by using simple programming steps in Microsoft EXCEL to generate the ta bles suggested by Commodity Security Branch (CSB).

The analysis was mainly descriptive and employed simple percentage distributions of variables that may have been filtered and refined. These we re supplemented by maps, tables and diagrams for illustrative purposes.

1.4.10 Limitations of the Survey

As with the 2010 survey, a major limitation of the study was the SDPs were treated as standalone units with no reference to the kind, number and characteristics of the catchment population that they service. Hence, direct information on cl ient characteristics came into the study only as a by-product of the data collection exercise. The importance of such pieces of information to policy formulation would be reduced. However, they can be relevant to forecasting of quantities of drugs and contraceptive commodit ies to ensure commodity security.

Respondents tended to forget or measure precisely the time durat ion within which essential maternal lifesaving medicines and modern contraceptive commodities w ere on ‘stock-out’. This may be because of two reasons. Firstly, reproductive health commodity security (RHCS), as a concept, is relatively new to Sierra Leone and indi vidual facilities may not have the culture of keeping information appertaining to it . Secondly, if the SDP was providing the service for less than six months preceding the survey or where the service personnel may have served the facility for periods of less than six months, the level of completeness of records will be negatively affected.

1.5 Outline of Report

The report is laid out in three main parts: the introduction , presentation of main findings and conclusion. In the first part, the introduction presents the contextual framework of the study including the country background information; the rationale a nd objectives of the survey; research methodology including sampling procedure, survey instrument (q uestionnaire), field data collection and data analysis; and, the limitat ions of the research design.

Part two concerns the key findings of the survey and is subdivided into four sections. The first section gives a background to the country’s health faciliti es. It describes the various categories of the facilities, their spatial spread, distances b etween them and their sources of supplies and the type of management.

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The second subsection discusses the modern contraceptives offered by t he facilities at national and subnational levels with respect to the various groups of SDPs in the country. The reasons why three modern methods of contraceptives are not provi ded in some facilities and peculiar reasons related to specific methods of co ntraception are highlighted.

The third subsection deals with variations in the availabili ty of maternal reproductive health medicines at the national and district levels. It discusses the availability of five essential lifesaving reproductive health medicines in the various types of SDPs in the country (the main indicator). It also explains why the medicines are not ava ilable in the health facilities; bringing out the sub-national dimension and the peculiarit y of these reasons to specific SDPs.

The last subsection of Part Two treats the incidence of ‘no stock out’ of modern contraceptives, bearing in mind that ‘no stock out’ is taken to mean a situation in which a family planning service delivery facility/service delivery point in the country did not run out of supplies of any one or more of the modern methods of contracepti ves at any point in time over the last/previous six months and therefore had supplies on h and to serve clients at all times. The occurrences of ‘no stock out’ in the last six months and ‘no stock out’ on the day of the interview were important to the analysis. In additi on, the occurrence of product specific ‘no stock out’ for each contraceptive method is examined a nd the reasons why the stock outs occurred analysed.

Part Three is the conclusion. It summarizes the key findings that are the basis of the recommendations that address the three indicators for which the su rvey was conducted.

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2.1 General Information about the Facilities13

2.1.1 Classification of Health Facilities

The health service delivery system in Sierra Leone has been organize d around the primary health care (PHC) concept for the past three decades 14. The system operates in three tiers: (a) primary or first level healthcare consisting of peripheral heal th units (community health centres (CHC), community health posts (CHP), and maternal an d child health posts (MCHP)); (b) secondary level care or district hospitals; and (c) tertiary level care or regional/national referral hospitals.

The study adopted this classification for clarity of findings a nd policy relevance. Accordingly, the service delivery points (SDPs) in the sample are distributed as sho wn in Table 8. The table tells that 69.9 per cent of the health facilities fall into the primary health service delivery system. Put against the 2010 survey results, this represents a 5.1 per cent increase in the representation of this group of facilities in the sample. Ju st over 28 per cent of the sample is secondary level care SDPs/facilities/hospitals and only one-fifti eth is of tertiary, referral level care. In general, the representation of MCHPs and CHCs in the sample reduced whilst the rest of the subsamples increased in 2011.

Table 8: Classification of Health Facilities: 2010-2011

2011 Survey Class of SDP Per cent (2010 Frequency Per cent Survey) MCHP 123 35.2 32.4 CHP 39 11.2 14.8 CHC 82 23.5 17.6 Secondary level SDPs 99 28.1 31.5 Tertiary level SDPs 6 2.0 3.7 Total N=349 100.0 N=108

According to the National Health Sector Strategic Plan (2010-20 15)15, the bedrock of the primary healthcare is the district health services that are made up of a network of Peripheral Health Units (PHUs), the District Hospitals and the District Hea lth Management Teams (DHMTs). The first line of health services are the PHUs which are sub-classified into three levels. The Maternal and Child Health Posts (MCHPs) are found i n villages and at small

13 The healthcare facilities analyzed in this survey are those that offer family planning and maternal health services. 14 The account in this section draws on: Government of Sierra Leone – National Health Sector Strategic Plan (2010-2015), Ministry of Health and Sanitation, Freetown; November 20 09: p.5. 15 Ib.id. March 2012 15 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT urban and peri-urban centres with populations of less than 5, 000. About 35 per cent of the sample is MCHPs (Table 8). The medical personnel manning MCHPs are mainly trained MCH Aides that provide services like family planning, immunization , health education, antenatal care, supervised deliveries, postnatal care, growth mon itoring and promotions for under-five children, management of minor ailments and referral of cases to the next level. The MCH Aides are supported by community health wor kers (TBAs, Community Volunteers, etc).

About one-eighth of the sample are Community Health Posts (CHPs) which are mainly located at the level of small towns with populations betw een 5,000 and 10,000 and are staffed by State Enrolled Community Health Nurses (SECHNs) and MCH A ides. CHPs provide the same types of services like MCHPs in addition to prevent ion and control of communicable diseases and rehabilitation. They refer more complicat ed cases to the Community Health Centres (CHCs) which are located at the chiefd om level, usually covering a population ranging from 10,000 to 20,000 and staffed with a Community Health Officer (CHO), SECHN, MCH Aides, an Epidemiological Disease Control Assist ant and an Environmental Health Assistant. CHCs are the highest level of primary healthcare and they constitute 23.5 per cent of the SDPs studied (Table 8). They provide all the services available at the CHP level in addition to environmental sanitation and supervise the CHPs and MCHPs within the chiefdom.

The District Hospitals are secondary level facilities providing ba ckstopping for the PHUs. There are 28.1 per cent of these in the sample. Their duties include outpatient services for referred cases from PHUs and the population living within thei r immediate environs, in-patient and diagnostic services, management of accidents and emergencies, and technical support to PHUs. The tertiary level SDPs are top level referral health units which also function as Teaching Hospitals 16.

2.1.2 Geographic Distribution of Facilities

Geographic distribution of the health facilities refers to t he provincial, district and rural-urban aerial spread of the SDPs over the administrative subdivisions of t he country. Out of 349 SDPs surveyed, about a third is the Northern Province, a sixth in th e Eastern Province and 26 per cent apiece in the Southern Province and Western Area (Ta ble 9). Against the 2010 survey, data show that whilst the proportion in the Southern Province virtually remained unchanged, that of the Western Area increased at the expense of the Eastern and Northern Provinces. If this change is decomposed, it shows that but for marginal increases in Kenema, Bombali and Moyamba Districts, the only significant rise in proportion since 2010 outside the Western Urban and Rural Areas is Bo District (Table 9).

The distribution by district ranges from 3.7 per cent in Pujehun District to 20.6 in the Western Area17. The Western Urban Area (the city of Freetown) and Bo District account for 32.6 per cent

16 Please note that Connaught Hospital, Freetown, did not qualify for inclusion in the study because it is not a facil ity that performs reproductive health service delivery functions. 17 This gives a range of 16.9 percent for 2011. The 2010 range was 13.9 percent. March 2012 16 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT of all health centres in Sierra Leone. Kenema, Port Loko and Bombali Districts together have a further 24.6 per cent of the health facilities. In sum, 35 per cent of the districts are home to 57 per cent of the SDPs.

Table 9: Distribution of SDPs by Province and District: 2010-2011

2011 Survey Province/District Per cent (2010 Frequency Per cent Survey); N=108

EASTERN 61 17.5 19.5 Kailahun 14 4.0 5.6 Kenema 30 8.6 8.3 Kono 17 4.9 5.6 106 30.3 32.4 NORTHERN Bombali 28 8.0 7.4 Kambia 16 4.6 4.6 Koinadugu 14 4.0 5.6 Port Loko 28 8.0 8.3 Tonkolili 20 5.7 6.5 91 26.1 26.9 SOUTHERN Bo 42 12.0 11.1 Bonthe 15 4.3 5.6 Moyamba 21 6.0 5.6 Pujehun 13 3.7 4.6 91 26.1 21.3 WESTERN Western Rural 19 5.4 3.7 Western Urban 72 20.6 17.6 Total 349 100.0* 100.0*

*Rounding off errors =0.1 per cent.

Analysing the geographic distribution of the health centres by rural and urban residence reveals that 214 (61.3 per cent) out of 349 are in the rural areas (Figure 2). (Therefore, 135 centres (38.7 per cent) are in urban localities.) In comparison to the rural-urban ratio of distribution of 53.7:46.3 respectively for the 2010 survey, th e sample selection of the 2011 survey follows almost exactly the actual rural-urban population di stribution of Sierra Leone. It has been noted that there is a tendency to locate service delivery points in settlements that are relatively better connected to road networks and, among urba n localities, there is a high level of skewness because Freetown (Western Urban) alone accounts f or over half of the secondary health facilities in Sierra Leone 18. Given the distribution of health centres by provincial, district and rural-urban residence patterns, therefore, much needs to be done to achieve a near equitable distribution.

18 Government of Sierra Leone and UNFPA (February 2011) – Su rvey of Availability of Modern Contraceptives and Essential Life-Saving Maternal and Reproductive Health Medicines in Service Delivery Points in Sierra Leone, GoSL/UNFPA, Freetown, Sierra Leone; p.14. March 2012 17 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Figure 2: Distribution of SDPs by Rural-Urban Location

Urban 39%

Rural 61%

2.1.3 Management of Facilities

The health sector in Sierra Leone is managed by many providers –go vernment, private individuals, faith based organizations (FBOs), non-governmental o rganizations (NGOs) and the forces. As shown in Figure 3, about 70 per cent of the facilities are managed by Government of Sierra Leone. One fifth of the management is done by FBOs and private health business concerns (including informal and undocumented tra ditional medical practitioners), NGOs make up 7.4 per cent and there are traces of SDPs managed by the police, military or fire force. Against the distribution of these managers, it would appear that in 2011 the number of FBOs and NGOs increased by eight and 1 .4 per cent respectively. Conversely, this nine per cent increment came from reductions in Go vernment, forces and privately managed facilities in the sample.

Figure 3: Percentage Distribution of SDPs by Type of Management

80 70 60 50 40 30 Per cent Per 20 10 0

FBO NGO Forces Private

Government Management Type

March 2012 18 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Each government health centre is supervised by a District Health Man agement Team (DHMT) that plans, implements, coordinates, monitors and evaluate s the district health services under the leadership of a District Medical Officer (DMO). T he Medical Officer in-charge-of the district hospital works with ex-officio members of va rious programs, projects and units19 as part of the DHMT.

Within the health sector in Sierra Leone, unlike in Ghana or elsewhere in sub-Saharan Africa, the private sector is underdeveloped and delivers services mai nly in curative care on a profit-making basis. The private health facilities are supervi sed by their individual owners and/or Boards of Directors. They are found mainly in urban local ities where they get patronage from members of higher socio-economic households. The in formal and undocumented traditional healers and Traditional Birth Atte ndants (TBAs) operate largely in rural areas and in urban slums and peri-urban suburbs 20.

2.1.4 Distance of Service Delivery Points from Source of Supplies

The importance of the distance variable in explaining accessibi lity to health services lies in the extent to which it discourages persons from commuting to a he alth centre. Also, if the distance between the SDP and the nearest warehouse from which it gets regular supplies is long, the combination of bad road networks and transportatio n costs undermine standards, availability and accessibility of services provided. This is especia lly so in rural areas where distance places a barrier to healthcare and related services and i mpairs standards, availability and accessibility of the services 21.

Table 10 displays information on distribution of SDPs by distan ce (miles) from the nearest warehouses. About a fifth of the SDPs and about another eighth are located within a mile and less than 10 miles of their warehouses respectively. Healt h centres located beyond 20 miles of their warehouses account for 53 per cent of the sample, compared with 38.3 per cent in 2010. Put against the situation in 2010 when a third of the SDPs were situated within one mile of the main source of supplies, the 2011 samples seem to be much further located from their warehouses.

2.2 Modern Contraceptives Offered by Facilities

2.2.1 Contraceptives Offered by Type of Facilities

About 82 per cent (285) of the health facilities in the sa mple provide family planning services and commodities. Male condoms, oral pills and injectables can b e found in 80 per cent of the SDPs and are, therefore, the favourite modern contraceptives p rovided to clients. A salient feature of the 2011 data is the prominence of fema le condoms (about 70 per cent) 22 in the contraceptive mix at the health facilities.

19 Op. cit., Government of Sierra Leone – National Health Sector Strategic Plan (2010-2015), Ministry of Health and Sanitation, Freetown; November 2009: p.5. 20 Ib. id., p.4 21 See, for example, ib. id., p.20. 22This shows an increase from 38 per cent in 2010. March 2012 19 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Table 10: Distribution of SDPs by Distance (Miles) from Nearest Ware house: 2010-2011

Distance (Miles) from 2011 Survey Per cent (2010 Nearest Warehouse Frequency Per cent Survey); N=107** 0-1 50 19.5 33.6 2-4 12 4.7 8.4 5-9 18 7.0 7.5 10-14 21 8.2 4.7 15-19 20 7.8 7.5 20-29 40 15.6 10.3 30-39 47 18.3 15.9 40+ 49 19.1 12.1 Total 257* 100.0 100.0

*Missing values = 92; **Missing values = 1.

Basically, but for IUDs and male sterilisation, SDPs were puttin g more of each kind of contraceptive on offer in 2011 than in 2010 (Figure 4). Th e availability of IUDs, implants and male and female sterilisation continue to be very low at less than 15 per cent. The least popular modern contraceptive methods are female and male steriliza tion.

Figure 4: Percentage Distribution of SDPs by General Availability of Modern Contraceptives

90 80 70 60 50 40 30 20 2011 10 0 2010

IUDs

Oral pills Implants Injectables Male condoms Female condoms Male sterilisation Female sterilisation

The availability of modern contraceptives is also analysed by leve l of facility in the healthcare continuum and the results shown in Table 11. It is encouraging to note that there is a general improvement in the provision of modern contraceptives at service delivery points across Sierra Leone. The table shows that this improved se rvice delivery is marked mainly at the primary level of healthcare where it involves the availability of all modern contraceptive methods. This outcome of the data reflects the commitment of Government

March 2012 20 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Table 11: Percentage Distribution of SDPs Offering Modern Cont raceptives by Type of Method of Contraception Primary Level Care SDPs Tertiary CONTRACEPTIVE Secondary Level Level Care METHOD CHC CHP MCHP Care SDPs SDPs MALE CONDOMS 23.8 (19.1) 13.5 (14.9) 41.5 (27.7) 20.2 (24.5) 1.1 (4.3) FEMALE CONDOMS 24.2 (17.0) 14.8 (14.9) 37.3 (31.9) 22.5 (23.4) 1.2 (4.3) ORAL PILLS 23.4 (2.1) 13.1 (0.0) 41.5 (0.0) 20.9 (8.5) 1.1 (0.0) INJECTABLES 22.8 (13.8) 13.5 (10.6) 41.6 (26.5) 21.0 (19.1) 1.1 (4.3) IUDs 10.6 (6.4) 8.5 (8.5) 8.5 (9.5) 66.0 (14.9) 6.4 (3.2) IMPLANTS 8.5 (0.0) 2.1 (0.0) 17.0 (0.0) 66.0 (2.1) 6.4 (0.0) FEMALE STERILIZATION 0.0 (0.0) 0.0 (0.0) 11.1 (0.0) 77.8 (9.5) 11.1 (1.1) MALE STERILIZATION 4.8 (2.1) 4.8 (0.0) 4.8 (0.0) 76.2 (8.5) 9.5 (0.0)

*2010 survey data are in brackets. commitment of Government of Sierra Leone and her health develop ment partners to the principle of integrating family planning into primary health care.

At the secondary level of healthcare, in response to the poor state of availability of modern contraceptives in government hospitals in 2010, significant step s were taken in 2011 to correct the situation. Although there was some improvement in t he provision of oral pills, condom programming at secondary level health facilities seemed to have reduced. Particular attention has been paid to the provision of IUDs, implants, and female and male sterilisation. Notably, about 70 per cent of all secondary level care SDPs has these contraceptive commodities. However, the four most popular contrace ptives of male and female condoms, oral pills and injectables are relatively underp rovided at secondary and tertiary levels of healthcare compared with what obtains at th e CHCs and MCHPs.

2.2.2 Facilities Offering at Least Three Types of Modern Contraceptives

One of the compelling reasons to conduct annual GPRHCS surveys ha s always been to generate information on the number of Stream One Countries wi th SDPs of at least three modern methods of contraceptives. In 2011, 80.5 per cent (281 out of 349) of the health facilities offered at least three modern contraceptive methods t o their clients (Table 12). This represents a drop of 6.7 per cent from the 2010 level of 87.2 per cent. The spread by type of SDP is 90.2 per cent for primary, 58.2 per cent for secondary and 50.0 per cent for tertiary health facilities. Moreover, the rural-urban distribution of facilities offering at least three types of modern contraception reveals that 91.1 per cent of rural SDPs are served as against 63.7 per cent of urban SDPs. The indication is that the previously underserved rural communities may have been deliberately targeted for improvement of service delivery in 2011 but the relatively low availability at urban centres is a cause for concern.

March 2012 21 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Table 12: Percentage Distribution of SDPs offering at Least T hree Modern Contraceptive Methods by Type of Facility – between facility type analysis: 2 010-2011 Per cent Offering at Per cent Not Offering at Type of Facility Least Three Modern Least Three Modern Number of SDPs Contraceptive Methods Contraceptive Methods MCHP 19.2 (17.0) 4.6 (2.1) 123 (18) CHP 10.9 (14.9) 0.3 (1.1) 39 (15) CHC 33.2 (28.7) 2.0 (3.2) 83 (30) Secondary SDPs 16.3 (22.3) 11.7 (6.4) 98 (27) Tertiary SDPs 0.9 (4.3) 0.9 (0.0) 6 (4) Total 80.5 (87.2) 19.5 (12.8) 349 (94)

*2010 survey data are in brackets .

In further analysing the criterion of three modern contraceptives across rural-urban residence patterns, Figure 5 shows that the percentage of SDPs n ot offering at least three modern contraceptives increased between 2010 and 2011 but thi s was as a result of a doubling of the urban SDPs; the proportion of rural SDPs remaine d almost unchanged. As the percentage of rural facilities that offer at least three modern contraceptive methods increased by a third, that of the urban SDPs decreased by almost h alf. Thus, unlike in 2010, rural localities seem to have received better attention in terms of provision of contraceptive commodities at SDPs. Although this rural bias in the data dep icts an equity situation, care should be taken not to unduly disadvantage the urban areas whilst improving the lot of rural dwellers.

Figure 5: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Rural-Urban Residence - Sierra Leone 2010 - 2011

90.0% 80.0% 70.0% 60.0% 50.0% Rural 40.0% Urban 30.0% Grand Total 20.0% 10.0% 0.0% 2011 2010 2011 2010

Not offering at least 3 modern Offering at least 3 modern contraceptive methods contraceptive methods

March 2012 22 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

In 2011, about 63 per cent of facilities offering at lea st three contraceptives are PHUs compared with 60 per cent in 2010. In addition, the CHC s are the largest providers representing a third of all SDPs that meet this criterion. Also in Table 12, there are reductions in the proportions of secondary and tertiary level hea lth facilities that were offering at least three modern contraceptive methods in 2011. In addition, the fact that about 19.5 per cent of the SDPs has only two types of contraceptives or less compared to only 12.8 per cent in 2010 depicts that the situation of contra ceptive commodity provision worsened in 2011. Most of the defaulting facilities are se condary SDPs.

With respect to the facility types, primary healthcare facilities are generally better resourced and the CHPs have the largest proportion by facility of provide rs of at least three modern contraceptive methods. There is a strong inverse correlation betwe en the hierarchy of the SDP and the level of availability of three or more modern meth ods of contraception (Table 13). Much needs to be done at the CHCs but the challenge is to ensure that referral facilities at the secondary and tertiary levels of healthcare provision meet this contraceptive criterion.

Table 13: Percentage Distribution of SDPs offering at Least T hree Modern Contraceptive Methods by Type of Facility – within facility type analysis: 20 11

Per cent Offering at Per cent Not Offering at Type of Facility Least Three Modern Least Three Modern Number of SDPs Contraceptive Methods Contraceptive Methods MCHP 94.3 5.7 123 (18) CHP 97.4 2.6 39 (15) CHC 80.7 19.3 83 (30) Secondary SDPs 58.2 41.8 98 (27) Tertiary SDPs 50.0 50.0 6 (4) Total 80.5 (87.2) 19.5 (12.8) 349 (94)

*2010 Survey figures are in bracket.

In disaggregating the analysis by district and with respect to the provision of three modern contraceptive methods, only three districts gained 100 per cent co verage – Koinadugu, Bonthe and Pujehun (Table 14). In addition, Kambia and Ka ilahun Districts have reasonably high levels of availability of contraceptives. These five dist ricts are located at the outermost extremes of the country and it is a good idea that they receive d such a markedly high attention in the provision of contraceptives in 2011. Bo Di strict, Western Rural and Urban Areas are the only places where the national average of 80.5 per cent is not attained.

Some more information show up when the analysis is done by distri ct to see how much each is contributing to contraceptive security at the national level (Table 15). Unlike in 2010 when the distribution of health centres according to whether they offer at least three modern contraceptive methods by administrative areas followed a self-weig hting design, the 2011 distribution shows significant shifts in the numbers. In 2011 , Bonthe, Koinadugu and Port Loko Districts increased their proportions in the class of SDPs with three or more

March 2012 23 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT contraceptives. Apart from Bombali, Bo and Moyamba Districts and the Western Rural Area where the percentages remained the same, the rest of the distri cts registered reductions in the proportions that met this criterion.

Per cent Offering at Least Three Modern Per cent Not Offering at Number Province/District Contraceptive Least Three Modern Methods Contraceptive Methods of SDPs EASTERN Kailahun 92.9 7.1 14 Kenema 83.3 16.7 30 Kono 88.2 11.8 17 NORTHERN Bombali 82.1 17.9 28 Kambia 93.8 6.3 16 Koinadugu 100.0 0.0 14 Port Loko 82.1 17.9 28 Tonkolili 80.0 20.0 20 SOUTHERN Bo 78.6 21.4 42 Bonthe 100.0 0.0 15 Moyamba 90.5 9.5 21 Pujehun 100.0 0.0 13 WESTERN Western Rural 63.2 36.8 19 Western Urban 62.5 37.5 72 Number of DPs 80.5 19.5 349

Pujehun, Bonthe and Koinadugu Districts did not have any SDP that was not offering three modern contraceptive methods in 2011. These three districts are l ocated in outlying environments with poor transport and communication networks conditi oned by either difficult relief (as in Koinadugu) or riverine countryside (as in Bonthe and Pujehun). Western Rural and Urban Areas and Bo District continue to register the highe st proportions of SDPs that do not have at least three modern contraceptive methods (Table 15). Western Urban Area and Bo and Kenema Districts possess about a third of the health cent res that offer at least three modern methods of contraception.

With regards to the distribution of health facilities by typ e of management, government health centres are the most important source of contraceptives. About 92 per cent of the facilities are offering at least three types of contraception (Table 16). Apart from about 70 per cent of the non-governmental facilities, the proportions of SD Ps of private concerns and faith-based organisations offering contraceptive commodities and services to the population are inadequate.

March 2012 24 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

For the private concerns, the problem is with the fact that UNFPA, the largest provider of contraceptives, insists on free delivery of commodities and services. T he faith-based organisations do not provide the commodities and services because o f religious reasons.

Table 17 displays further analysis of data on the management of health facilities. The table reveals that within the category of those facilities offering at least three modern methods of contraception in 2010-2011, Government of Sierra Leone remains t he largest provider of contraceptives and manages two thirds of the sample SDPs. Except fo r the faith-based health facilities, the proportion offering three modern cont raceptives generally reduced for all categories of management. But whereas the proportion not off ering three modern contraceptive methods reduced for government managed SDPs, it increase d by more than double for the SDPs managed by private for-profit individuals an d institutions, NGOs and FBOs.

Table 15: Percentage Distribution of SDPs offering at Least T hree Modern Contraceptive Methods by District – between district analysis: 2010-2011

Per cent Offering at Least Three Modern Per cent Not Offering at Number Province/District Contraceptive Least Three Modern Methods Contraceptive Methods of SDPs EASTERN Kailahun 3.7 (5.3) 0.3 (1.1) 14 (6) Kenema 7.2 (8.5) 1.4 (0.0) 30 (8) Kono 4.3 (6.4) 0.6 (0.0) 17 (6) NORTHERN Bombali 6.6 (6.4) 1.4 (0.0) 28 (6) Kambia 4.3 (5.3) 0.3 (0.0) 16 (5) Koinadugu 4.0 (3.2) 0.0 (1.1) 14 (4) Port Loko 6.6 (5.3) 1.4 (1.1) 28 (6) Tonkolili 4.6 (7.4) 1.1 (0.0) 20 (7) SOUTHERN Bo 9.5 (9.6) 2.6 (1.1) 42 (10) Bonthe 4.3 (3.2) 0.0 (3.2) 15 (6) Moyamba 5.4 (5.3) 0.6 (1.1) 21 (6) Pujehun 3.7 (4.3) 0.0 (0.0) 13 (4) WESTERN Western Rural 3.4 (3.2) 2.0 (1.1) 19 (4) Western Urban 12.9 (13.8) 7.7 (3.2) 72 (16) Number of DPs 281 (82) 68 (12) 349 (94)

*2010 Survey figures are in brackets.

March 2012 25 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

For the private concerns, the problem is with the fact that UNFPA, the largest provider of contraceptives, insists on free delivery of commodities and services. T he faith-based organisations do not provide the commodities and services because o f religious reasons.

Table 17 displays further analysis of data on the management of health facilities. The table reveals that within the category of those facilities offering at least three modern methods of contraception in 2010-2011, Government of Sierra Leone remains t he largest provider of contraceptives and manages two thirds of the sample SDPs. Except for the faith-based health facilities, the proportion offering three modern cont raceptives generally reduced for all categories of management. But whereas the proportion not off ering three modern contraceptive methods reduced for government managed SDPs, it increase d by more than double for the SDPs managed by private for-profit individuals and institutions, NGOs and FBOs.

Table 16: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Type of Management: within Management Type Analysis

Offering at Least Three Not Offering at Least Type of Management Modern Contraceptive Three Modern Number of SDPs Methods Contraceptive Methods Government 91.9 8.1 247 Private 40.5 59.5 37 NGO 69.2 30.8 26 FBO 52.6 47.4 38 FORCE 100.0 0.0 1 Number of SDPs 281 68 349

The management boards need to monitor this trend for improvement s to be effected in the delivery of contraceptive services. Part of the reason for this may be that as the principal contraceptive provider to all SDPs in Sierra Leone, UNFPA in 201 1 insisted that user fees related to contraceptive services be dropped by all beneficiary SDPs. Many would prefer not to offer the services because their primary motive is profit-making. To fill the gap left by their withdrawal, alternative outlets and outreach services need to be sought to ensure that the situation does not deteriorate any further.

Table 17: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods across the Management Types: 2010-2011

Offering at Least Three Not Offering at Least Type of Management Modern Contraceptive Three Modern Number of SDPs Methods Contraceptive Methods Government 65.0 (69.1) 5.7 (8.5) 247 (73) Private 4.3 (8.5) 6.3 (3.2) 37 (11) NGO 5.2 (6.4) 2.3 (1.1) 26 (7) FBO 5.7 (1.1) 5.2 (0.0) 38 (1) FORCE 0.3 (2.1) 0.0 (0.0) 1 (2) Number of SDPs 281 (82) 68 (12) 349 (94) *2010 survey figures are in brackets. March 2012 26 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

If the analysis is also done for SDPs located within specific di stances away from their warehouses of usual supply, it shows that except for health ce ntres located at distances over 50 miles, location of a facility to a warehouse does not con fer any advantage of availability of supplies (Figure 6). This outcome of the data is at variance with the results of the 2010 survey which suggested that distance may have a drawback effect on efforts at providing healthcare in hard-to-reach areas 23. The suggestion is that Government, through Ministry of Health and Sanitation, has used the recommendations of the 2010 survey and taken steps to reverse the situation.

2.2.3 Reasons for Not Offering Certain Contraceptives

The main reasons why certain contraceptives are not offered at th e SDPs have remained virtually the same since the 2010 survey. Male condom, oral pill s and injectables are the most popular types and are nearly always available. Female cond oms, oral pills and injectables are also fairly available but they may suffer from sto ck-outs especially in the Northern Province.

The IUD, implant and sterilisation for males and females gen erally suffer from problems of inadequate or no trained personnel at the SDPs to administer them. Such SDPs would normally not put these contraceptives on offer. Low client d emand because of a phobia for the side effects of the long acting contraceptives is also a less important reason for non-availability of these contraceptives. In a few instances, especially for private health facilities, the reason why client uptake of contraceptives is lo w is because people would prefer to get free supplies from government facilities or from NGOs like Marie Stopes Society of Sierra Leone.

23 Government of Sierra Leone and UNFPA (February 2011) – op . cit; p.15 March 2012 27 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

2.3 Availability of Maternal and Reproductive Health Medicines

2.3.1 Maternal and RH Medicines Available by Types of Facilities

In 2011, 295 (84.5 per cent of) health facilities were off ering maternal and reproductive health medicines to the population in their catchment areas. Although the proportion is higher than that providing family planning services and commodit ies, there is a reduction of 10 per cent in comparison with the 2010 level.

Data in Table 18 show that none of the lifesaving medici nes is provided in all of the health facilities that usually provide the drugs. This is not a very good outcome of the data for a country with about the highest maternal mortality rate. Iron/folate is the most popular and is available at about 78 per cent of the facilities. Magnesi um sulphate, metronidazole and oxytocine are available for between 61-69 per cent of the he alth facilities. Between 54-58 per cent of the SDPs have amoxicillin, clotrimazole and ergometrin on offer. The poorest availability of these drugs relate to azithromycin (15.5 per cent ) and cefexime (9.7 per cent).

Table 18: Percentage Distribution of Availability of Essentia l Lifesaving Maternal/ Reproductive Health Medicines by Type of SDP

Lifesaving Type of SDP GRAND TOTAL PER Maternal/RH Drug CHC CHP MCHP SECONDARY TERTIARY NUMBER CENT Amoxycillin 21.6 12.1 33.2 31.1 2.1 190 54.4 Azithromycin 22.2 11.1 24.1 37.0 5.6 54 15.5 Benzathine Penicillin 25.1 9.4 36.8 26.3 2.3 171 49.0 Cefexime 26.5 2.9 5.9 55.9 8.8 34 9.7 Clotrimazole 23.8 10.9 35.2 27.5 2.6 193 55.3 Ergometrin 19.7 12.3 37.4 28.6 2.0 203 58.2 Iron/Folate 23.5 12.1 39.7 22.8 1.8 272 77.9 Magnesium Sulfate 23.2 14.1 41.1 20.3 1.2 241 69.1 Metronidazole 23.2 12.1 34.4 28.6 1.8 224 64.2 Oxytocine 22.0 13.1 36.0 26.6 2.3 214 61.3

Considering the availability of the drugs by type of SDP, Table 18 further tells that the CHCs and MCHPs account for about 60 per cent of all the available drugs captured in the 2011 survey. Except for secondary level facilities and CHCs, cefexime is re latively scarce in the rest of the SDPs which together hold less than 18 per cent of the drug.

In Table 19, a comparison of the availability of lifesaving drugs in 2010-2011 is made. But for azithromycin and iron/folate, the level of availability i n 2010 was higher than in 2011 for all types of drugs. This confirms the general trend that has run through this analysis that the availability of essential lifesaving drugs and contraceptives see m to have worsened in 2011. The presence of azithromycin and cefexime continue to be low key over the past two years.

March 2012 28 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Further in Table 19, it is shown that in 2010, all respon ses of drug availability were verified to be true as the percentage of drugs that was available at the time of the survey exactly matched that for the inventory check exercise. In 2011, not only is there a mismatch Table 19: General Availability of Life-Saving Maternal or RH Medicines; 2010-2011

Inventory taken, Life-Saving Maternal or Currently Available medicine in stock RH Medicines % 2010 % 2011 % 2010 % 2011

Amoxycillin 64.8 54.4 64.8 50.4 Azithromycin 13.9 15.5 13.9 14.6 Benzathine Penicillin 64.8 49.0 64.8 44.4 Cefexime 16.7 9.7 16.7 8.0 Clotrimazole 63.0 55.3 63.0 50.4 Ergometrine 61.1 58.2 61.1 55.0 Iron/Folate 74.1 77.9 74.1 70.8 Magnesium Sulfate 85.2 69.1 85.2 61.9 Metronidazole 75.0 64.2 75.0 57.3 Oxytocine 63.0 61.3 63.0 57.6 Number of SDPs 108 349 108 349 between the two responses, the actual availability from the inventory check was lower than what the respondents said in most cases. The variance was much la rger in the cases of iron/folate, magnesium sulphate and metronidazole. It is no t known why the variances occurred for each and every drug type but the inclusion of a trace r drug module in the questionnaire may have affected the responses.

2.3.2 Availability of Five Essential Life-Saving Maternal and RH Medicines

The most important index for UNFPA Global Programme on Reproduct ive Health Commodity Security (GPRHCS) is the percentage of SDPs where five selected (including three essential) lifesaving maternal/reproductive health medicines are available in all facilities providing delivery services. The study result shows that 91.2 per cent of the SDPs satisfy the requirements of this index; 80.4 per cent for urban and 96.5 per cent for rural areas. The availability at primary health centres is 96.4, 76. 1 for secondary and 60.0 per cent for tertiary level health facilities (Figure 7). Essentially, therefore, the li kelihood of meeting the requirements of this index is negatively correlated with the hierarchy of th e healthcare continuum.

The study analysed the index of five maternal/reproductive heal th lifesaving medicines by district. The percentage of SDPs with the drugs available revea led the biggest variations in distribution in the study (Figure 8). The percentage offerin g ranged from 40 per cent in Moyamba and Kambia Districts to 100 per cent in Port Loko District. The strange result is the 48 per cent in Bombali District. This is one of two model UNFPA programme districts and is, therefore, expected to be better resourced. Worse still, Moyamba, Kambia and Bombali districts have more health facilities that do not offer five (at least three essential) lifesaving maternal or reproductive health medicines than otherwise. March 2012 29 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Figure 7: Percentage Distribution of SDPs with Five (including Three Essential) Lifesaving Maternal/RH

Medicines Available by Type of Facility

100.0 90.0 80.0 70.0 Not Offering at Least Five 60.0 (including Three Essential) 50.0 Lifesaving Maternal/RH 40.0 Medicines 30.0 Offering at Least Five 20.0 (including Three Essential) 10.0 Lifesaving Maternal/RH 0.0 Medicines

PRIMARY TERTIARY SECONDARY

This notwithstanding, the percentages for the Western Rural and Urban Areas, situated very close to the Central Medical Stores, is not better off. Not only are these places showing worse off in this section of the analysis, they are also not better off in terms of the contraceptives. This is a major deterioration in this aspect of the healthcare delivery system in Sierra Leone. As these are lifesaving drugs, urgent steps sho uld be taken to rectify the situation and gradually improve it.

Figure 8: Percentage distribution of SDPs with five (including 3 essential) lifesaving maternal / reproductive health medicines available by district

100.0% 80.0% Not Offering Five (including 60.0% Three Essential) Life Saving 40.0% Maternal or Reproductive 20.0% Health Medicines

0.0% Offering Five (including

Bo Three Essential) Life-Saving Kono Maternal or Reproductive Bonthe Kambia Bombali Kenema Pujehun Tonkolili Kailahun

Moyamba Health Medicines Port Loko koinadugu Western Rural Western Western Urban Western

March 2012 30 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Table 20 displays the analysis of how the availability of f ive (including three essential) lifesaving maternal or reproductive health medicines are distribut ed by type of management of health facility. The health facilities managed by no ngovernmental organisations are most likely to provide the drugs, followed by faith-based organisat ions and private institutions. Government institutions are the worst providers; well over a quart er of them and the one military facility that fell into the sample do not put lifesaving maternal or reproductive health drugs on offer.

Table 20: Percentage Distribution of SDPs with five (including Three Essential) Lifesaving Maternal/Reproductive Health Medicines Available by Management Type

Offering Five (including Not Offering Five Type of Management Number of SDPs Three Essential (including Three Lifesaving Essential Lifesaving Maternal/Reproductive Maternal/Reproductive Health Medicines Health Medicines

Government 71.4 28.6 231 Private 85.0 15.0 20 NGO 93.7 6.3 16 FBO 88.9 11.1 27 FORCE 0.0 100.0 1 Number of SDPs 221 74 295

As with the analysis on contraceptive availability, distance d oes not seem to have a decisive effect on drug availability. The highest levels of non-ava ilability of the medicines can be found among SDPs located very near to (between 5-19 miles radius) a nd mid-range (25-29 and 35-39 miles radius) from the warehouses (Table 21). In betw een these distances are considerable variations but, generally, the proportion offeri ng five (including three essential) maternal or reproductive health medicines increases with distance f rom the warehouse of usual supply. These findings are similar to the ones on avai lability of three modern contraceptive methods (Figure 6, pages 26-27) above and show tha t distance did not have a meaningful frictional effect on the supply of maternal/rep roductive health medicines.

2.3.3 Reasons for Not Offering Certain Lifesaving Maternal and Reproductive Health Medicines

In 2010, there were two main reasons why some life-saving materna l and reproductive health medicines were not offered at the SDPs – stock-out and t hat the medicine was not on offer at the health facility. In 2011, the only main reason for unavailability of these medicines was lack of supply. With the exception of magnesium sulphate and iron/folate, the rest of the medicines were not offered at most of the SDPs (Table 22). The number of SDPs experiencing lack of supply ranged from 20.3 (for metronidazole) to 74.2 per cent (for cefexime). The drugs with the highest levels of neglect are a moxicillin, benzathine penicillin, cefexime and azithromycin.

March 2012 31 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Table 21: Percentage Distribution of SDPs with five (including Three Essential) Life-saving Maternal/Reproductive Health Medicines Available by Distance (Mil es) from the Nearest Warehouse – within distance analysis

Not Offering at Least Offering at Least Three Distance (Miles) from Three Modern Modern Contraceptive Number of SDPs Nearest Warehouse Contraceptive Methods Methods 0-4 13.0 87.0 46 5-9 50.0 50.0 16 10-14 33.3 66.7 15 15-19 42.1 57.9 19 20-24 21.1 78.9 19 25-29 35.3 64.7 17 30-39 15.8 84.2 19 35-39 30.8 69.2 26 40-44 25.0 75.0 4 45-49 22.2 77.8 9 50+ 20.0 80.0 40 Total 25.7 74.3 230* *Missing values = 119.

In 2011, therefore, there were only traces of other reasons for not offering the drugs apart from the reason of lack of supply. These included non-offer o f medicines at the SDP, patients preferring to buy their drugs from outside the health facility, the medical doctor preferring an alternative drug, expensiveness of the medicine, l ow client demand and fear of side effects (Table 22).

2.4 Incidence of ‘No Stock Outs’ of Modern Contraceptives

2.4.1 ‘No Stock Out’ at Time of Survey

Measuring ‘no stock out’ at the time of the survey gives a snap shot of the ready availability of contraceptives in the health centres across the country. Minima l stock outs indicate that men and women of all ages can access the type of contraceptive t hey desire.

In Table 23, it can be seen that male and female condoms, oral pills and injectables (in order of importance) were generally available at the time of the su rvey. Sterilization for males and females were the most unpopular brands of contraceptives in stock. Their absence at the CHCs and CHPs may be connected with the lack of trained personn el to handle the task at those levels. Female sterilization, in particular, has shown no improvement as it accounted for 2.5 and 2.1 per cent of the samples in 2011 and 2010 respectively.

March 2012 32 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Table 22: Lifesaving Maternal and RH Medicines by Main Reason for Non-Availability at SDPs: 2010-2011

Reasons for Non-availability of Drugs* Life-Saving Maternal and RH Out of stock Medicine is Patients Not the Long distance Low client Medicines or no supply not offered buy drugs choice of to buy drug demand or at SDP outside the doctor or drug is fear of side expensive effects Amoxycillin 31.2 (15.7) (14.8) 0.3 - - - Azithromycin 68.5 (25.0) 0.3 (53.7) 0.3 - 0.6 (1.9) - Benzathine Penicillin 36.7 (17.6) (12.0) - 0.3 - - Cefexime 74.2 (25.0) (51.9) - (0.6) (0.9) - Clotrimazole 29.5 (17.6) (13.9) - 0.6 - 0.6 Ergometrine 25.8 (12.0) (22.2) - - - 0.3 Iron/Folate 7.2 (12.0) (8.3) - - - - Magnesium Sulfate 15.5 (3.7) (6.5) - - - - Metronidazole 20.3 (11.1) 8.3 - - - (0.9) Oxytocine 23.8 (8.3) 23.1 - 0.3 - - No. of SDPs 295 (103) 295 (103) 295 295 (103) 295 (103) 295 (1 03)

*2010 survey figures are in brackets.

By analysing contraceptive commodities by rural-urban residence pattern (Table 24), it is seen that there are clear cut rural-urban differentials in the type of commodity in stock at the time of the survey. As usual, all kinds of commodities were offered at the urban centres. Even in the rural areas, commodities were fairly available except t hat female and male sterilization were absent at all the rural health facilitie s.

Table 23: Percentage Distribution of SDPs with Modern Contracep tive Methods in Stock at the Time of the Survey by Type of Facility: 2010-2011

Contraceptive Method Primary Level Care SDPs Tertiary In Stock At Time of Secondary Level Level Care Survey CHC CHP MCHP Care SDPs SDPs MALE CONDOMS 23.2 (19.1) 13.3 (14.9) 38.9 (27.7) 18.2 (24.5) 1.1 (4.3) FEMALE CONDOMS 14.0 (17.0) 10.5 (14.9) 22.8 (31.9) 14.4 (23.4) 1.1 (4.3) ORAL PILLS 21.8 (3.2) 13.0 (1.1) 38.9 (0.0) 19.6 (11.7) 1.1 (2.1) INJECTABLES 17.5 (2.1) 10.5 (0.0) 35.1 (0.0) 17.9 (8.5) 1.1 (0.0) IUDs 1.8 (13.8) 1.8 (10.6) 1.4 (26.6) 8.1 (19.1) 1.1 (4.3) IMPLANTS 1.4 (6.4) 0.7 (8.5) 2.5 (9.6) 8.1 (14.9) 1.1 (3.2) FEMALE STERILIZATION 0.0 (0.0) 0.0 (0.0) 0.4 (0.0) 6.0 (2.1 0.7 (0.0) MALE STERILIZATION 0.0 (0.0) 0.0 (0.0) 0.4 (0.0) 1.8 (9.6) 0.4 (1.1) *2010 survey figures in brackets.

Overall, the percentages of all the commodity types recorded in 2 010 in the urban areas were higher than those for 2011 except for oral pills. In t he rural areas, whilst the

March 2012 33 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT percentages for male condom, oral pills and injectables increased , those for female condoms and implants reduced (Table 24). Although there is sti ll room for improvement, the degree of availability of contraceptive commodities in the rural areas is encouraging and efforts at improving the current rural contraceptive availability sh ould be supported.

Table 24: Percentage Distribution of SDPs with Modern Contracep tive Methods in Stock at the Time of the Survey by Rural and Urban Residence*: 2010-201 1

Contraceptives in Stock Rural Urban at Time of Survey

Male Condom 63.9 (40.4) 26.0 (50.0) Female Condom 34.7 (43.6) 18.2 (47.9) Oral Pill 61.1 (3.2) 27.7 (14.9) Injectable 47.7 (34.0) 22.1 (40.4) IUD** 2.8 8.1 Implant 2.8 (16.0) 9.1 (26.6) Female Sterilization 0.0 (0.0) 1.8 (2.1) Male Sterilization 0.0 (0.0) 5.6 (10.6) Number of SDPs 214 (42) 135 (52)

*2010 survey data in brackets; **Data for 2010 not available.

2.4.2 ‘No Stock Out’ in the Last Six Months

The percentage of SDPs with ‘no stock outs’ of contraceptives wit hin the last six months before the survey is the third and last indicator for which the UNFPA Global Programme on Reproductive Health Commodity Security (GPRHCS) commissions the annual surveys on availability of modern contraceptives. The index gives an indi cation of the extent of ‘no stock-outs’ at the health facilities. Data reveal that, nationwide, only 35.42 per cent of the SDPs experienced ‘no stock-outs’ in the six months preceding the 201 1 survey. It can be noted that in comparison with the 2010 figure of 41.35 p er cent, an average of six more out of every 100 health facilities in 2011 experienced stock outs. In the six months preceding the survey, the percentage of no stock outs in the rural areas was 35.5 and that for the urban centres was 31.3. The level of no stock out for primary, secondary and tertiary level facilities was 35.2, 30.7 and 29.2 respectively.

In the rural areas, the no stock out situation with respect to male and female condoms, IUDs and implants show a more reliable supply chain management system (T able 25). Oral pills, injectables and male and female sterilization were virtually i n stock outs in the six months before the survey. At the urban centres, though the pattern of no stock out seems similar, there are, in addition, trace levels of no stock outs for oral pills, injectables and male and female sterilization.

March 2012 34 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Table 25: Percentage Distribution of SDPs with Modern Contracep tive Methods with No Stock out in the Last Six Months by Rural and Urban Residence

Modern Contraceptive Rural Urban Methods

Male Condom 30.0 21.9 Female Condom 28.7 23.4 Oral Pill 1.3 6.8 Injectable 1.3 7.7 IUD 22.4 18.6 Implant 16.3 15.4 Female Sterilization 0.0 1.5 Male Sterilization 0.0 4.7 Total 100.0 100.0 Number of SDPs 607 338

The low level of presence of these four types of modern contrace ptives in both the rural and urban areas goes beyond mere lack of requisite personnel to admin ister the services. The reasons may include fear of side effects due to low level of se nsitization to create demand and cultural resistance to family planning generally.

For each contraceptive commodity, a detailed analysis compared avai lability at rural and urban areas. The resultant picture (Figure 9) closely replicates t he information in Table 25. Rural areas are seen to provide about 70 per cent of male cond oms, 67 per cent of oral pills, injectables and female condoms but no sterilization services. On the other hand, all the few sterilization and about 75 per cent of IUDs and implant servi ces performed are at the urban centres. In addition, a little under a third of the condoms, oral pills and injectables are found in urban places (Figure 9).

Figure 9: Percentage Distribution of SDPs with No Stock outs of Modern Contraceptives in the Last Six Months by Urban and Rural Residence

100 90 80 70 60 50 40 30 20 RURAL 10 URBAN 0

IUDs

IMPLANTS ORAL PILLS INJECTABLES MALE CONDOMS FEMALE CONDOMS MALE STERILIZATION FEMALE STERILIZATION

March 2012 35 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

In 2010, female and male condoms were the most readily availab le contraceptives as they did not experience ‘stock outs’ at over 85 per cent of the SDPs, followed by IUDs. In 2011, the most readily available contraceptives were male condoms and ora l pills (Table 26). Injectables and female condoms were fairly available but there were very high levels of stock-outs of IUDs, implants, and male and female sterilization. Though the availability situation of the MCHPs and CHCs is much better than other SDPs, the general pattern of provision of the contraceptives is similar across SDPs. There was much imp rovement in the availability of oral pills and injectables. However, there were equally significant increases of ‘stock-outs’ of female condoms, IUDs, implants, and male and female sterilization (Table 26).

Table 26: Percentage Distribution of Service Delivery Points wit h No Stock Out of Modern Contraceptive Methods in the Last Six Months by Type of Facility*: 2010-2011

Primary Level Care SDPs Secondary Tertiary level Contraceptive level care care SDPs Total Method CHC CHP MCHP SDPs

MALE CONDOMS 21.8 (18.1) 12.3 (12.8) 37.5 (26.6) 17.5 (23.4) 0.7 (4.3) 89.5 (85.1) FEMALE CONDOMS 12.6 (17.0) 8.8 (14.9) 17.9 (29.8) 13.0 (21.3) 0.7 (4.3) 53.0 (87.2) ORAL PILLS 21.1 (3.2) 11.6 (1.1) 36.8 (1.1) 18.6 (12.8) 0.7 (2.1) 88.8 (20.2) INJECTABLES 15.4 (2.1) 8.4 (0.0) 29.5 (1.1) 15.8 (5.3) 0.7 (0.0) 69.8 (8.5) IUDs 1.4 (13.8) 0.7 (9.6) 1.1 (24.5) 7.0 (16.0) 0.7 (4.3) 10.9 (68.1) IMPLANTS 1.4 (6.4) 0.4 (8.5) 2.1 (10.6) 7.4 (12.8) 0.7 (3.2) 11.9 (41.5) FEMALE 0.0 (1.1) 0.0 (0.0) 0.4 (2.1) 4.9 (4.3) 0.4 (0.0) 5.6 (7.4) STERILIZATION MALE STERILIZATION 0.0 (1.1) 0.0 (1.1) 0.4 (2.1) 1.1 (7.4) 0.4 (1.1) 1.8 (12.8)

*2010 Survey data in brackets.

In Figure 10, the percentage distribution of SDPs with no st ock outs in the six months before the survey by level of health facility is displayed. The figu re shows that a third of tertiary level facilities had no stock outs of female and male condoms, oral p ills, IUDs, implants and injectables. In addition, with respect to sterilization fo r males and females, it was only a sixth of them. The no stock out situation of secondary health facilities (hospitals) was low for most of the contraceptive commodities. It was barely about 50 per cent for male condoms and oral pills, about 40 per cent for injectables and male condo ms, about 20 per cent for IUDs and implants, and worst for all forms of sterilization. As in all these analyses, the fundamental providers of short term contraceptives (male and female condoms and oral pills) and injectables are primary healthcare centres (Figure 10).

2.4.3 Reasons for ‘Stock Out’

Five main reasons were given by the respondents for stock outs: (a) p roblems with the distribution system, (b) out of stock because of lack of supply, (c) no clients (patients do not come for it for fear of side effects), (d) no skilled staff and (e) people do not want to pay for contraceptives. The problems with the distribution system affect the rate of supply to the

March 2012 36 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

Figure 10: Percentage Distribution of SDPs with No Stock outs in the Six Months before the Survey by Level of SDP

90.0

80.0

70.0

60.0

50.0

40.0 PRIMARY 30.0 SECONDARY 20.0 TERTIARY

10.0

0.0

IUDs Oral pills Implants Injectables Male condom Female condoms Sterilisation for Males Sterilisation for Females health facilities and the frequency of stock outs. This is true mainly for condoms (male and female) and oral pills. The unwillingness of people to p ay for contraceptives and fear of side effects of some of the long-term methods severely limits the number of clients that demand the commodities and services. In turn, these make some SDPs not to stock commodities for which there is low demand and, hence, stock outs. Problems of l ack of skilled personnel to deliver contraceptive services (of IUDs, implants and injectables, a nd sterilization) are mainly prevalent in rural and peri-urban areas where such services end up not being available to clients.

March 2012 37 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT PART III: CONCLUSION

3.1 Summary of Findings

Contraceptive prevalence remains very low (less than 10 per cent) in Sierra Leone, among all categories of persons and across the age spectrum. Unmet need for family planning services remains high at 28 per cent. Contraceptive availability depends on free supplies that come mainly from UNFPA and supply chain management systems are weak. Although maternal mortality dropped from over 1,300 to 857 deaths per 10 0,000 live births between 2000 and 2008, the high levels of unwanted and teenag e pregnancies pose a threat to efforts at maternal mortality reduction.

In 2010 to 2011, there was a general improvement in the pro vision of modern contraceptives at service delivery points across Sierra Leone. But health faciliti es continue to suffer from frequent stock outs of modern methods of contraception. The ability to provide the method mix is greatly compromised by lack of trained personnel and low capa city in logistic management. Although the availability of the female cond om increased between 2010 and 2011, there is much to be desired from the supply system considering the generally low level of availability of male and female sterilization, implants a nd IUDs.

In 2011, there was a reduction in the percentage of availa bility of essential lifesaving maternal or reproductive health medicines in service delivery points in the country. Iron/folate is the most popular and can be found in about 80 per cent of the SDPs whereas azithromycin (15.5 per cent) and cefexime (9.7 per cent) are the lea st available. These two drugs, together with metronidazole, amoxicillin and benzathin e penicillin experience the most stock outs. The greatest variations were in the availabili ty of five (including three essential) lifesaving medicines. The percentage offering range d from 40 in Kambia and Moyamba to 100 per cent in Port Loko District.

The encouraging outcome of data in 2011 is that rural areas were better served than in 2010 for both the lifesaving drugs and contraceptives. Distance had no significant attrition effect on the level of provision of commodities or drugs and surprisingly , SDPs closest to the regular supply warehouses seemed to be underserved. The main reaso n for the stock outs was lack of supply to replenish existing stock probably because the health centres were overwhelmed with demands escalated by the partial free health care initiative of Government of Sierra Leone24.

3.2 Recommendations

The issues revealed by data analysis form the basis of recommendatio ns for policy options for planning and programming of modern contraceptive commodities a nd services, and provision of essential lifesaving maternal/reproductive health me dicines. The recommendations will inform the repositioning of family planni ng and deepening of programming for emergency obstetric care in Sierra Leone. The recommend ations are:

24 All user fees for pregnant women and lactating mother s was abolished on 27th April 2010. March 2012 38 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME ONE –ANALYTICAL REPORT

(a) Government of Sierra Leone should continue to deepen famil y planning services by maintaining it as an integrated part of primary healthcare. This requires the enforcement of the primary healthcare policy even in health cent res owned by non-governmental and faith-based organizations and private-for-pro fit institutions. Efforts should also be made to encourage the ma nagement of these health facilities that are not run by Government to accommodate family planning as part of their services with user fees either removed or kept at cost-recovery levels. To fill the gap left by the withdrawal profit-makin g health facilities from the free delivery of contraceptives, alternative outlets and outreach services need to be sought to ensure that the situation does not deteriorat e any further; (b) The report is replete with gross inadequacies of human resource s for the delivery of long-term contraceptive methods to the population. In the short term, there is need to train a core group of health service personnel to start the delivery process. In the medium term, it is necessary to include this as a module in the training of health service personnel at the intermediate leve l; (c) More efforts at demand creation are needed to increase contracep tive uptake especially in communities in poor road network environments. Famil y planning can be used as an entry point into community development initi atives. This should involve community sensitization and male involvement to we aken cultural stereotypes currently inhibiting family planning practices; (d) Operations researches on the contraceptive prevalence are necessary t o inform the current repositioning of family planning in the country. A baseline, midterm and end line surveys will provide the opportunity for benchmarkin g and constantly monitoring progress in family planning interventions, and (e) The logistic management system should be further strengthened to minimize stock outs especially of lifesaving maternal/reproductive health me dicines. The situation of ineffective supplies of cefexime, azithromycin, metro nidazole, amoxicillin and benzathine penicillin needs special investiga tion to know why the drugs are frequently out of stock. A more robust and effective monitoring of the situation is also recommended for efficient forecasting and supp ly chain management of the drugs and contraceptives.

March 2012 39 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO -TABLES VOLUME TWO: TABLES

TABLE OF CONTENT

Content Page

Table 1: Types of Service Delivery Points Providing Modern Methods of Contraception in Sierra Leone by Administrative Unit . . . 43

Table 2: Relative Proportion of Categories of SDPs in Sierra Leone . . 43

Table 3: Minimal Sample Sizes for Sierra Leone Based on 95 Per ce nt Confidence Interval (Z-score = 1.96) and 5 Per cent Confidence Limit against Number of SDPs per Stratum . . . . 44

Table 4: Corrected Minimal Sample Sizes for Sierra Leone Based on the 95 Per cent Confidence Interval and 5 Per cent Confiden ce Limit . 44

Table 5: Proportion of Categories of Service Delivery Points by Administrative Units ...... 45

Table 6: Distribution of Minimal Sample Sizes for Each Category of SDP in Sierra Leone Z(95% 0.05) ...... 46

Table 7: Sampling Intervals for the Respective Geographic Subdi visions of Sierra Leone Z(95% 0.05) ...... 47

Table 8: Classification of Health Facilities: 2010-2011 . . . . 47

Table 9: Distribution of SDPs by Province and District: 2010-2011 . . 48

Table 10: Distribution of SDPs by Rural-Urban Location: 2010 -2011 . . 48

Table 11: Distribution of SDPs by Type of Management . . . . 49

Table 12: Distribution of SDPs by Distance (Miles) from Nearest Warehouse: 2010-2011 ...... 49

Table 13: Percentage Distribution of SDPs by General Availabi lity of Modern Contraceptives: 2010-2011 ...... 50

Table 14: Percentage Distribution of SDPs Offering Modern Con traceptives By Type of Method of Contraception: 2010-2011 . . . . 50

March 2012 40 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Content Page

Table 15: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Type of Facility – between facility type analysis: 2010-2011 . . . . . 51

Table 16: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Rural-Urban Residence: 2010-2011 . . . . . 51

Table 17: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Type of Facility – within facility type analysis: 2010-2011 ...... 51

Table 18: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by District – within district analysi s . 52

Table 19: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by District – between districts analysis: 2010-2011 ...... 53

Table 20: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Type of Management – within Management Type Analysis: 2010-2011 . . . . . 53

Table 21: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Type of Management – across the Management Types: 2010-2011 ...... 54

Table 22: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Distance (Miles): 2010-2011 . . . 54

Table 23: Percentage Distribution of Availability of Essenti al Lifesaving Maternal or Reproductive Health Medicines by Type of SDP . . 55

Table 24: General Availability of Life-Saving Maternal or R H Medicines: 2010-2011 ...... 55

Table 25: Percentage Distribution of SDPs with Five (includin g Three Essential) Lifesaving Maternal/Reproductive Health Medicines Available by Management Type . . . . . 56

March 2012 41 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO - TABLES

Content Page

Table 26: Percentage Distribution of SDPs with Five (includin g Three Essential) Lifesaving Maternal/Reproductive Health Medicines Available by Distance (Miles) from the Nearest Warehouse – withi n distance analysis ...... 56

Table 27: Life-Saving Maternal and RH Medicines by Main Rea son for Non-Availability at SDP: 2010-2011 . . . . . 57

Table 28: Percentage Distribution of SDPs with Modern Contra ceptive Methods in Stock at the Time of the Survey by Type of Facility: 2010-2011 ...... 57

Table 29: Percentage Distribution of SDPs with Modern Contra ceptive Methods in Stock at the Time of the Survey by Rural and Urban Residence: 2010-2011 ...... 58

Table 30: Percentage Distribution of Service Delivery Points wi th No Stock Out of Modern Contraceptive Methods in the Last Six Months by Rural and Urban Residence ...... 58

Table 31: Percentage Distribution of Service Delivery Points wi th No Stock Out of Modern Contraceptive Methods in the Last Six Months by Type of Facility: 2010-2011 ...... 59

Table 32: Health Facility Listing – Category of General SDPs, Sierra Leone 2011 ...... 60

Table 33: Health Facility Listing – Category of Communit y Health Centres, Sierra Leone 2011 ...... 65

Table 34: Health Facility Listing – Category of Communit y Health Posts, Sierra Leone 2011 ...... 70

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 ...... 78

ANNEXES

ANNEX A: SURVEY QUESTIONNAIRE ...... 97

March 2012 42 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO - TABLES TABLES

Table 1: Types of Service Delivery Points Providing Modern Methods of Contraception in Sierra Leone by Administrative Unit

Types of Service Delivery Points/facilities/ hospitals (or equivalent) Administrative Unit: Province Tertiary level Secondary Level Primary Level Total and District Care Care Care EASTERN Kailahun 0 3 78 81 Kenema 1 11 112 124 Kono 0 2 82 84 NORTHERN Bombali 1 10 95 106 Kambia 0 5 60 65 Koinadugu 0 4 67 71 Port Loko 0 9 108 117 Tonkolili 0 5 89 94 SOUTHERN Bo 1 24 108 133 Bonthe 0 6 51 57 Moyamba 0 7 92 99 Pujehun 0 2 63 65 WESTERN Rural 0 10 38 48 Urban 2 64 42 108 TOTAL 5 162 1,085 1,252

Table 2: Relative Proportion of Categories of SDPs in Sierra L eone

Types of Service Delivery Points/facilities/ hospitals (or equivalent) Parameter Tertiary level Secondary Level Primary Level Total Care Care Care Number of SDPs 5 162 1,085 1,252 Relative Proportion 0.004 0.1294 0.8666 1.0000

March 2012 43 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO - TABLES

Table 3: Minimal Sample Sizes for Sierra Leone Based on 95 Per Ce nt Confidence Interval (Z-score = 1.96) and 5 Per cent Confidence Limit against Number of SDPs per Stratum

Types of Service Delivery Points/facilities/ hospitals (or equivalent) Parameter Tertiary level Secondary Level Primary Level Total Care Care Care Minimum sample 6 173 178 357 size based on 95% confidence interval (Z = 1.96) and 5% confidence limit (d = 0.05) Number of SDPs 5 162 1,085 1,252

Table 4: Corrected Minimal Sample Sizes for Sierra Leone Based on the 95 Per cent Confidence Interval and 5 Per Cent Confidence Limit

Types of Service Delivery Points/facilities/ hospitals (or equivalent) Parameter Tertiary level Secondary Level Primary Level Total Care Care Care Minimum sample 5 162 178 345 size based on 95% confidence interval (Z = 1.96) and 5% confidence limit (d = 0.05)

March 2012 44 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO - TABLES

Table 5: Proportion of Categories of Service Delivery Points by Ad ministrative Unit

Types of SDPs/facilities/ hospitals (or equivalent) Administrative Unit: Province Tertiary level Secondary Level Primary Level Total and District Care Care Care EASTERN Kailahun 0.00 0.02 0.07 0.06 Kenema 0.20 0.07 0.10 0.10 Kono 0.00 0.01 0.08 0.07 NORTHERN Bombali 0.20 0.06 0.09 0.08 Kambia 0.00 0.03 0.06 0.05 Koinadugu 0.00 0.02 0.06 0.06 Port Loko 0.00 0.06 0.10 0.09 Tonkolili 0.00 0.03 0.08 0.08 SOUTHERN Bo 0.20 0.15 0.10 0.11 Bonthe 0.00 0.04 0.05 0.04 Moyamba 0.00 0.04 0.08 0.08 Pujehun 0.00 0.01 0.06 0.05 WESTERN Rural 0.00 0.06 0.03 0.04 Urban 0.40 0.40 0.04 0.09 TOTAL 1.00 1.00 1.00 1.00

March 2012 45 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 6: Distribution of Minimal Sample Sizes for Each Category o f SDP in Sierra Leone Z(95% 0.05)

Types of SDPs/facilities/ hospitals (or equivalent) Administrative Unit: Province Tertiary level Secondary Level Primary Level Total and District Care Care Care EASTERN Kailahun 0 3 12 15 Kenema 1 11 18 30 Kono 0 2 14 16 NORTHERN Bombali 1 10 16 27 Kambia 0 5 11 16 Koinadugu 0 3 11 14 Port Loko 0 10 18 28 Tonkolili 0 5 14 19 SOUTHERN Bo 1 24 18 43 Bonthe 0 7 9 16 Moyamba 0 7 14 21 Pujehun 0 2 11 13 WESTERN Rural 0 10 5 21 Urban 2 65 7 74 TOTAL 5 164 178 353

March 2012 46 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 7: Sampling Intervals for the Respective Geographic Subdi visions of Sierra Leone Z(95% 0.05)

Province / District Sample (n) Population (N) i = N/n EASTERN Kailahun 12 81 7 Kenema 18 124 7 Kono 14 84 6 NORTHERN Bombali 16 106 7 Kambia 11 65 6 Koinadugu 11 71 7 Port Loko 18 117 7 Tonkolili 14 94 7 SOUTHERN Bo 18 133 7 Bonthe 9 57 6 Moyamba 14 99 7 Pujehun 11 65 6 WESTERN Rural 5 48 10 Urban 7 108 15 TOTAL 178 1252 7

Table 8: Classification of Health Facilities: 2010-2011

2011 Survey Per Cent (2010 Class of SDP Frequency Per Cent Survey)

MCHP 123 35.2 32.4 CHP 39 11.2 14.8 CHC 82 23.5 17.6 Secondary Level 99 28.1 31.5 SDPs Tertiary Level 6 2.0 3.7 SDPs Total N=349 100.0 N=108

March 2012 47 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO - TABLES

Table 9: Distribution of SDPs by Province and District: 2010-2011

2011 Survey Province/District Per Cent (2010 Frequency Per Cent Survey); N=108

EASTERN 61 17.5 19.5 Kailahun 14 4.0 5.6 Kenema 30 8.6 8.3 Kono 17 4.9 5.6 NORTHERN 106 30.3 32.4 Bombali 28 8.0 7.4 Kambia 16 4.6 4.6 Koinadugu 14 4.0 5.6 Port Loko 28 8.0 8.3 Tonkolili 20 5.7 6.5 SOUTHERN 91 26.1 26.9 Bo 42 12.0 11.1 Bonthe 15 4.3 5.6 Moyamba 21 6.0 5.6 Pujehun 13 3.7 4.6 WESTERN 91 26.1 21.3 Western Rural 19 5.4 3.7 Western Urban 72 20.6 17.6 Total 349 100.0* 100.0* *Rounding off errors =0.1 per cent.

Table 10: Distribution of SDPs by Rural-Urban Location: 2010-2 011

2011 Survey Residence Per Cent (2010 Survey) Frequency Per Cent Rural 214 61.3 53.7 Urban 135 38.7 46.3 Total N=349 100.0 N=108

March 2012 48 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO - TABLES

Table 11: Distribution of SDPs by Type of Management: 2010-2011

2011 Survey Management Per Cent (2010 Survey) Frequency Per Cent Faith-based Organizations 38 10.9 2.8 Forces 1 0.3 1.9 Government 247 70.8 74.1 Non-Governmental Organization 26 7.4 6.5 Private 37 10.6 13.9 Total N=349 100.0 N=108

Table 12: Distribution of SDPs by Distance (Miles) from Nearest Warehouse: 2010-2011

2011 Survey Per Cent (2010 Distance from Nearest Survey); Warehouse (Miles) Frequency Per Cent N=107** 0-1 50 19.5 33.6 2-4 12 4.7 8.4 5-9 18 7.0 7.5 10-14 21 8.2 4.7 15-19 20 7.8 7.5 20-29 40 15.6 10.3 30-39 47 18.3 15.9 40+ 49 19.1 12.1 Total 257* 100.0 100.0 *Missing values = 92; **Missing values = 1.

March 2012 49 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO - TABLES

Table 13: Distribution of SDPs by General Availability of Mod ern Contraceptives: 2010-2011

2011 Survey Per Cent (2010 Management Frequency Per Cent Survey) Male Condoms 282 80.8 79.6 Female Condoms 244 69.9 38.0 Oral Pills 282 80.8 81.5 Injectables 281 80.5 74.1 IUDs 47 13.5 16.7 Implants 47 13.5 11.1 Sterilization for Males 21 6.0 10.2 Sterilization for Females 9 2.6 2.8 Total N=349 100.0 N=108

Table 14: Percentage Distribution of SDPs Offering Modern Cont raceptives by Type of Method of Contraception: 2010-2011 Primary Level Care SDPs Tertiary CONTRACEPTIVE Secondary Level Level Care METHOD CHC CHP MCHP Care SDPs SDPs MALE CONDOMS 23.8 (19.1) 13.5 (14.9) 41.5 (27.7) 20.2 (24.5) 1.1 (4.3) FEMALE CONDOMS 24.2 (17.0) 14.8 (14.9) 37.3 (31.9) 22.5 (23.4) 1.2 (4.3) ORAL PILLS 23.4 (2.1) 13.1 (0.0) 41.5 (0.0) 20.9 (8.5) 1.1 (0.0) INJECTABLES 22.8 (13.8) 13.5 (10.6) 41.6 (26.5) 21.0 (19.1) 1.1 (4.3) IUDs 10.6 (6.4) 8.5 (8.5) 8.5 (9.5) 66.0 (14.9) 6.4 (3.2) IMPLANTS 8.5 (0.0) 2.1 (0.0) 17.0 (0.0) 66.0 (2.1) 6.4 (0.0) FEMALE STERILIZATION 0.0 (0.0) 0.0 (0.0) 11.1 (0.0) 77.8 (9.5) 11.1 (1.1) MALE STERILIZATION 4.8 (2.1) 4.8 (0.0) 4.8 (0.0) 76.2 (8.5) 9.5 (0.0)

*2010 survey data are in brackets.

March 2012 50 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO - TABLES

Table 15: Percentage Distribution of SDPs offering at Least Three Modern Contraceptive Methods by Type of Facility – between facility type analysis: 2010-2011

Per Cent Offering at Per Cent Not Offering Number of Type of Facility Least Three Modern at Least Three Modern Contraceptive Contraceptive Methods SDPs Methods

MCHP 19.2 (17.0) 4.6 (2.1) 123 (18) CHP 10.9 (14.9) 0.3 (1.1) 39 (15) CHC 33.2 (28.7) 2.0 (3.2) 83 (30) Secondary SDPs 16.3 (22.3) 11.7 (6.4) 98 (27) Tertiary SDPs 0.9 (4.3) 0.9 (0.0) 6 (4) Total 80.5 (87.2) 19.5 (12.8) 349 (94)

*2010 survey data are in brackets.

Table 16: Percentage Distribution of SDPs offering at Least Three Modern Contraceptive Methods by Rural-Urban Residence: 2010-2011 Per Cent Offering at Per Cent Not Offering Number of Type of Facility Least Three Modern at Least Three Modern Contraceptive Contraceptive Methods SDPs Methods

Rural 91.1 (88.1) 8.9 (11.9) 214 (42) Urban 63.7 (86.5) 36.3 (13.5) 135 (52) *2010 survey data are in brackets.

Table 17: Percentage Distribution of SDPs offering at Least Three Modern Contraceptive Methods by Type of Facility – within facility type analysis: 2011 Per Cent Offering at Per Cent Not Offering Number of Type of Facility Least Three Modern at Least Three Modern Contraceptive Contraceptive Methods SDPs Methods

MCHP 94.3 5.7 123 (18) CHP 97.4 2.6 39 (15) CHC 80.7 19.3 83 (30) Secondary SDPs 58.2 41.8 98 (27) Tertiary SDPs 50.0 50.0 6 (4) Total 80.5 (87.2) 19.5 (12.8) 349 (94) *2010 survey data are in brackets.

March 2012 51 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 18: Percentage Distribution of SDPs offering at Least Three Modern Contraceptive Methods by District – within district analysis

Per Cent Not Per Cent Offering at Offering at Least Number Province / District Least Three Modern Three Modern Contraceptive Contraceptive of Methods Methods SDPs

EASTERN Kailahun 92.9 7.1 14 Kenema 83.3 16.7 30 Kono 88.2 11.8 17 NORTHERN Bombali 82.1 17.9 28 Kambia 93.8 6.3 16 Koinadugu 100.0 0.0 14 Port Loko 82.1 17.9 28 Tonkolili 80.0 20.0 20 SOUTHERN Bo 78.6 21.4 42 Bonthe 100.0 0.0 15 Moyamba 90.5 9.5 21 Pujehun 100.0 0.0 13 WESTERN Western Rural 63.2 36.8 19 Western Urban 62.5 37.5 72 Number of DPs 80.5 19.5 349

March 2012 52 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 19: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by District – between district analysis: 2010-2011

Per Cent Not Per Cent Offering at Offering at Least Number Province / District Least Three Modern Three Modern Contraceptive Contraceptive of Methods Methods SDPs

EASTERN Kailahun 3.7 (5.3) 0.3 (1.1) 14 (6) Kenema 7.2 (8.5) 1.4 (0.0) 30 (8) Kono 4.3 (6.4) 0.6 (0.0) 17 (6) NORTHERN Bombali 6.6 (6.4) 1.4 (0.0) 28 (6) Kambia 4.3 (5.3) 0.3 (0.0) 16 (5) Koinadugu 4.0 (3.2) 0.0 (1.1) 14 (4) Port Loko 6.6 (5.3) 1.4 (1.1) 28 (6) Tonkolili 4.6 (7.4) 1.1 (0.0) 20 (7) SOUTHERN Bo 9.5 (9.6) 2.6 (1.1) 42 (10) Bonthe 4.3 (3.2) 0.0 (3.2) 15 (6) Moyamba 5.4 (5.3) 0.6 (1.1) 21 (6) Pujehun 3.7 (4.3) 0.0 (0.0) 13 (4) WESTERN Western Rural 3.4 (3.2) 2.0 (1.1) 19 (4) Western Urban 12.9 (13.8) 7.7 (3.2) 72 (16) Number of DPs 281 (82) 68 (12) 349 (94)

*2010 Survey figures are in brackets.

Table 20: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Type of Management: within Management Type Analysis

Offering at Least Not Offering at Least Type of Three Modern Three Modern Number of Management Contraceptive Contraceptive SDPs Methods Methods Government 91.9 8.1 247 Private 40.5 59.5 37 NGO 69.2 30.8 26 FBO 52.6 47.4 38 FORCE 100.0 0.0 1 Number of SDPs 281 68 349

March 2012 53 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 21: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods across the Management Types: 2010-2011

Offering at Least Not Offering at Least Type of Three Modern Three Modern Number of Management Contraceptive Contraceptive SDPs Methods Methods Government 65.0 (69.1) 5.7 (8.5) 247 (73) Private 4.3 (8.5) 6.3 (3.2) 37 (11) NGO 5.2 (6.4) 2.3 (1.1) 26 (7) FBO 5.7 (1.1) 5.2 (0.0) 38 (1) FORCE 0.3 (2.1) 0.0 (0.0) 1 (2) Number of SDPs 281 (82) 68 (12) 349 (94)

*2010 survey figures are in brackets.

Table 22: Percentage Distribution of SDPs Offering at Least Three Modern Contraceptive Methods by Distance (Miles): 2010-2011

Offering at Least Not Offering at Least Distance (Miles) Three Modern Three Modern Number of Contraceptive Contraceptive SDPs Methods Methods 0 – 4 71.0 29.0 62 5 – 9 94.4 5.6 18 10-14 86.7 13.3 15 15-19 94.7 5.3 19 20-29 87.5 12.5 40 30-39 95.7 4.3 46 40+ 87.7 12.3 57 Number of SDPs 221 36 257

March 2012 54 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 23: Percentage Distribution of Availability of Essentia l Lifesaving Maternal/ Reproductive Health Medicines by Type of SDP

Type of SDP GRAND TOTAL Lifesaving Maternal/RH Drug CHC CHP MCHP SECONDARY TERTIARY NUMBER PER CENT

Amoxycillin 21.6 12.1 33.2 31.1 2.1 190 54.4 Azithromycin 22.2 11.1 24.1 37.0 5.6 54 15.5 Benzathine Penicillin 25.1 9.4 36.8 26.3 2.3 171 49.0 Cefexime 26.5 2.9 5.9 55.9 8.8 34 9.7 Clotrimazole 23.8 10.9 35.2 27.5 2.6 193 55.3 Ergometrin 19.7 12.3 37.4 28.6 2.0 203 58.2 Iron/Folate 23.5 12.1 39.7 22.8 1.8 272 77.9 Magnesium Sulfate 23.2 14.1 41.1 20.3 1.2 241 69.1 Metronidazole 23.2 12.1 34.4 28.6 1.8 224 64.2 Oxytocine 22.0 13.1 36.0 26.6 2.3 214 61.3

Table 24: General Availability of Life-Saving Maternal or RH Medicines; 2010-2011:

Inventory taken, medicine Life-Saving Currently Available in stock Maternal or RH Medicines % 2010 % 2011 % 2010 % 2011

Amoxycillin 64.8 54.4 64.8 50.4 Azithromycin 13.9 15.5 13.9 14.6 Benzathine Penicillin 64.8 49.0 64.8 44.4 Cefexime 16.7 9.7 16.7 8.0 Clotrimazole 63.0 55.3 63.0 50.4 Ergometrine 61.1 58.2 61.1 55.0 Iron/Folate 74.1 77.9 74.1 70.8 Magnesium Sulfate 85.2 69.1 85.2 61.9 Metronidazole 75.0 64.2 75.0 57.3 Oxytocine 63.0 61.3 63.0 57.6 Number of SDPs 108 349 108 349

March 2012 55 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 25: Percentage Distribution of SDPs with Five (including Three Essential) Lifesaving Maternal/Reproductive Health Medicines Available by Management Type

Offering Five Not Offering Five Number of Type of (including Three (including Three SDPs Management Essential Lifesaving Essential Lifesaving Maternal/Reproductive Maternal/Reproductive Health Medicines Health Medicines Government 71.4 28.6 231 Private 85.0 15.0 20 NGO 93.7 6.3 16 FBO 88.9 11.1 27 FORCE 0.0 100.0 1 Number of SDPs 221 74 295

Table 26: Percentage Distribution of SDPs with Five (including Three Essential) Life-saving Maternal/Reproductive Health Medicines Available by Distance (Mil es) from the Nearest Warehouse – within distance analysis

Not Offering at Least Offering at Least Three Number of Distance (Miles) Three Modern Modern Contraceptive SDPs from Nearest Contraceptive Methods Warehouse Methods

0-4 13.0 87.0 46 5-9 50.0 50.0 16 10-14 33.3 66.7 15 15-19 42.1 57.9 19 20-24 21.1 78.9 19 25-29 35.3 64.7 17 30-39 15.8 84.2 19 35-39 30.8 69.2 26 40-44 25.0 75.0 4 45-49 22.2 77.8 9 50+ 20.0 80.0 40 Total 25.7 74.3 230* *Missing values = 119.

March 2012 56 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 27: Lifesaving Maternal and RH Medicines by Main Reason for Non-Availability at SDPs: 2010-2011 Reasons for Non-availability of Drugs* Life-Saving Maternal and RH Not the Long distance Low client Medicine is Patients Medicines Out of stock choice of to buy drug or demand or or no supply not offered buy drugs the doctor drug is fear of side at SDP outside expensive effects Amoxycillin 31.2 (15.7) (14.8) 0.3 - - - Azithromycin 68.5 (25.0) 0.3 (53.7) 0.3 - 0.6 (1.9) - Benzathine Penicillin 36.7 (17.6) (12.0) - 0.3 - - Cefexime 74.2 (25.0) (51.9) - (0.6) (0.9) - Clotrimazole 29.5 (17.6) (13.9) - 0.6 - 0.6 Ergometrine 25.8 (12.0) (22.2) - - - 0.3 Iron/Folate 7.2 (12.0) (8.3) - - - - Magnesium Sulfate 15.5 (3.7) (6.5) - - - - Metronidazole 20.3 (11.1) 8.3 - - - (0.9) Oxytocine 23.8 (8.3) 23.1 - 0.3 - - No. of SDPs 295 (103) 295 (103) 295 295 (103) 295 (103) 295 (103)

*2010 survey figures are in brackets.

Table 28: Percentage Distribution of SDPs with Modern Contracep tive Methods in Stock at the Time of the Survey by Type of Facility: 2010-2011

Contraceptive Primary Level Care SDPs Secondary Tertiary level Method In Stock level care care SDPs At Time of Survey CHC CHP MCHP SDPs

MALE CONDOMS 23.2 (19.1) 13.3 (14.9) 38.9 (27.7) 18.2 (24.5) 1.1 (4.3) FEMALE CONDOMS 14.0 (17.0) 10.5 (14.9) 22.8 (31.9) 14.4 (23.4) 1.1 (4.3) ORAL PILLS 21.8 (3.2) 13.0 (1.1) 38.9 (0.0) 19.6 (11.7) 1.1 (2.1) INJECTABLES 17.5 (2.1) 10.5 (0.0) 35.1 (0.0) 17.9 (8.5) 1.1 (0.0) IUDs 1.8 (13.8) 1.8 (10.6) 1.4 (26.6) 8.1 (19.1) 1.1 (4.3) IMPLANTS 1.4 (6.4) 0.7 (8.5) 2.5 (9.6) 8.1 (14.9) 1.1 (3.2) FEMALE STERILIZATION 0.0 (0.0) 0.0 (0.0) 0.4 (0.0) 6.0 (2.1 0.7 (0.0) MALE STERILIZATION 0.0 (0.0) 0.0 (0.0) 0.4 (0.0) 1.8 (9.6) 0.4 (1.1)

*2010 survey figures are in brackets.

March 2012 57 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 29: Percentage Distribution of SDPs with Modern Contracep tive Methods in Stock at the Time of the Survey by Rural and Urban Residence*: 2010-2011

Contraceptives in Stock Rural Urban At the Time of the Survey

Male Condom 63.9 (40.4) 26.0 (50.0) Female Condom 34.7 (43.6) 18.2 (47.9) Oral Pill 61.1 (3.2) 27.7 (14.9) Injectable 47.7 (34.0) 22.1 (40.4) IUD** 2.8 8.1 Implant 2.8 (16.0) 9.1 (26.6) Female Sterilization 0.0 (0.0) 1.8 (2.1) Male Sterilization 0.0 (0.0) 5.6 (10.6) Number of SDPs 214 (42) 135 (52)

*2010 survey data in brackets; **Data for 2010 not available.

Table 30: Percentage Distribution of SDPs with No Stock Out of Modern Contraceptive Methods in the Last Six Months by Rural and Urban Residence

Modern Contraceptive Rural Urban Methods

Male Condom 30.0 21.9 Female Condom 28.7 23.4 Oral Pill 1.3 6.8 Injectable 1.3 7.7 IUD 22.4 18.6 Implant 16.3 15.4 Female Sterilization 0.0 1.5 Male Sterilization 0.0 4.7 Total 100.0 100.0 Number of SDPs 607 338

March 2012 58 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 31: Percentage Distribution of Service Delivery Points wit h No Stock Out of Modern Contraceptive Methods in the Last Six Months by Type of Facility*: 2010-2011

Primary Level Care SDPs Secondary Tertiary level Contraceptive level care care SDPs Total Method CHC CHP MCHP SDPs

MALE CONDOMS 21.8 (18.1) 12.3 (12.8) 37.5 (26.6) 17.5 (23.4) 0.7 (4.3) 89.5 (85.1) FEMALE CONDOMS 12.6 (17.0) 8.8 (14.9) 17.9 (29.8) 13.0 (21.3) 0.7 (4.3) 53.0 (87.2) ORAL PILLS 21.1 (3.2) 11.6 (1.1) 36.8 (1.1) 18.6 (12.8) 0.7 (2.1) 88.8 (20.2) INJECTABLES 15.4 (2.1) 8.4 (0.0) 29.5 (1.1) 15.8 (5.3) 0.7 (0.0) 69.8 (8.5) IUDs 1.4 (13.8) 0.7 (9.6) 1.1 (24.5) 7.0 (16.0) 0.7 (4.3) 10.9 (68.1) IMPLANTS 1.4 (6.4) 0.4 (8.5) 2.1 (10.6) 7.4 (12.8) 0.7 (3.2) 11.9 (41.5) FEMALE STERILIZATION 0.0 (1.1) 0.0 (0.0) 0.4 (2.1) 4.9 (4.3) 0.4 (0.0) 5.6 (7.4) MALE STERILIZATION 0.0 (1.1) 0.0 (1.1) 0.4 (2.1) 1.1 (7.4) 0.4 (1.1) 1.8 (12.8)

*2010 Survey data in brackets.

March 2012 59 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 32: Health Facility Listing – Category of General SDPs, Sierra Leone 2011

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

1 30 Elshaddai Clinic Bunumbu General 2 47 Kailahun Government Hospital General 3 48 Marie Stopes Clinic, Kailahun General 4 67 Nixon Memorial Hospital General 5 77 KDHCO Clinic Pendembu General 6 143 Panguma Mission Hospital General 7 182 Kenema Government Hospital General 8 183 M I Room (Military) General 9 185 Ahmadiyya Muslim Hospital Kenema General 10 186 Nixon Satellite Clinic General 11 187 Marie Stopes Clinic, Kenema General 12 188 PPASL Clinic, Kenema General 13 189 SL Red Cross Clinic, Kenema General 14 190 Dama Surgery General 15 191 Nongowa Clinic General 16 192 Ralph Mini Hospital General 17 195 Kenema Diocesan Health Care General 18 232 Koidu Government Hospital General 19 233 Arab Clinic General 20 234 Marie Stopes Clinic, Koidu General 21 235 SL Red Cross Clinic, Koidu General 22 236 EM&BEE Maternity Home General 23 237 Fatkom Muchendeh Maternity Clinic General 24 266 Catholic Clinic, Yengema General 25 267 UMC Mitchener Memorial Maternity & Health Centre General 26 295 Chinese Clinic General 27 296 The White House Clinic General 28 320 Makeni Government Hospital General 29 321 Teko Barracks Clinic General 30 323 African Muslim Agency (AMA) General 31 324 UMC Clinic, Manonko General 32 325 Marie Stopes Clinic, Makeni General 33 326 SL Red Cross Clinic, Makeni General 34 327 City Garden General 35 328 Sabib Clinic General

March 2012 60 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 32: Health Facility Listing – Category of General SDPs, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

36 367 Holy Spirit Hospital General 37 368 Mabenteh Community Hospital General 38 402 Kamakwie Wesleyan Hospital General 39 431 Kambia Government Hospital General 40 432 Ahamadiyya Muslim Hospital General 41 433 SL Red Cross Clinic, Kambia General 42 460 Kasirie Health Centre (BCSL) /Baptist Centre CHP General 43 471 WCSL Clinic/Madina Wesleyan Mission General 44 527 Nasara Clinic General 45 541 Kabala Government Hospital General 46 542 Marie Stopes Clinic, Kabala General 47 543 SL Red Cross Clinic, Kabala General 48 583 Lungi Government Hospital General 49 584 Modia General Clinic General 50 585 New Life Clinic, Yongoro General 51 586 St. John of God Catholic Clinic General 52 587 WHR & Relief Arab Clinic General 53 588 Bai Bureh Memorial Community Hospital General 54 633 Port Loko Government Hospital General 55 634 SLC Port Loko (Rural Health Centre) General 56 641 St. John of God Catholic Hospital General 57 695 Magburaka Government Hospital General 58 696 SL Red Cross Clinic, Magburaka General 59 753 Ahmadiyya Muslim Hospital General 60 754 Our Lady of Guadalupe Clinic General 61 755 UMC Health Centre, Yonibana General 62 756 Marie Stopes Clinic, Mile 91 General 63 799 Catholic Hospital, Serabu General 64 830 Bo Government Hospital General 65 831 Mercy Ship Hospital General 66 832 Elshadai Medical Centre General 67 833 Morning Star Clinic General 68 834 SDA Clinic General 69 835 St Monica's Clinic General 70 836 UMC Health Centre, Manjama General

March 2012 61 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 32: Health Facility Listing – Category of General SDPs, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

71 837 Marie Stopes Clinic, Bo General 72 838 PPASL Clinic, Bo General 73 839 Praise Foundation Clinic General 74 840 SL Red Cross Clinic, Bo General 75 842 Chinese Clinic General 76 843 Dr Boima Clinic General 77 844 Holy Mary Hospital General 78 845 Kindoyal Hospital General 79 846 Agape Way Clinic General 80 847 Bucksal Clinic General 81 848 Chinese (Fu-Qing) Clinic General 82 849 Kpolies Clinic General 83 850 Ndegbomie Clinic General 84 851 Sam Lean's Matenity Clinic General 85 852 Yimoh Clinic General 86 866 St Mary's Catholic Clinic, Sumbuya General 87 908 Sierra Rutile Clinic General 88 919 UBC Hospital, Mattru General 89 920 SL Red Cross Clinic, Mattru Jong General 90 938 Bonthe Government Hospital General 91 939 St. Joseph's Clinic General 92 940 SL Red Cross Clinic, Bonthe General 93 963 UMC Hartsfield Memorial Hospital, Rotifunk General 94 997 Moyamba Government Hospital General 95 999 St Joseph Clinic Moyamba General 96 1000 SL Red Cross Clinic, Moyamba General 97 1018 UMC Health Centre, Taiama General 98 1029 St. Mary's Clinic General 99 1047 CoTN Nguala Clinic General 100 1080 Pujehun Government Hospital General 101 1081 Marie Stopes Clinic, Pujehun General 102 1152 Benguema Military Clinkic General 103 1153 7th Battalion Military Clinic (Goderich MI Room) General 104 1154 Adventist Health System General 105 1155 Afro Arab Clinic General

March 2012 62 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 32: Health Facility Listing – Category of General SDPs, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

106 1156 Gospel Health Centre General 107 1157 New Life Clinic General 108 1158 Goderich Emergency Surgical Centre General 109 1159 Marie Stopes Clinic, Kossoh Town General 110 1163 Katalana Clinic General 111 1164 Muctual Faith Clinic General 112 1205 King Harman Road Hospital General 113 1206 Kingtom Police Hospital (MI Room) General 114 1207 Lumley Government Hospital General 115 1208 Macauley Satellite Hospital General 116 1209 Military Clinic, Cockeril HQ General 117 1210 Prison Hospital General 118 1211 Rokupa Government Hospital General 119 1212 Wilberforce Military Hospital General 120 1213 Connaught Hospital General 121 1214 PCM Hospital General 122 1215 Juba Military Clinic General 123 1216 Murray Town Military Clinic General 124 1217 Aberdeen Women Centre (Mercy Ship Hosp) General 125 1218 Holy Mary Clinic General 126 1219 IDEMSIL Hospital, Kissy Dockyard General 127 1220 UMC Hospital (Urban Centre), Kissy General 128 1221 AAK Association Arab Clinic General 129 1222 Ahmadiyya Muslim Health Centre, Calaba Town Genera l 130 1223 Al-Khatab Clinic, Calaba Town General 131 1224 Arab Clinic General 132 1225 EL- Shaddai Clinic General 133 1226 God's Favour SPI Unit General 134 1227 IDEMSIL Health Centre, East Brook Street General 135 1228 IDEMSIL Health Centre, Wellington General 136 1229 Methodist Church SL Community Clinic General 137 1230 New Harvest Clinic General 138 1231 Sierra Leone International Mission Clinic SLIM Genera l 139 1232 St Luke's Clinic General 140 1233 St Anthony's Clinic General

March 2012 63 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 32: Health Facility Listing – Category of General SDPs, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

141 1234 Stella Maria Clinic General 142 1235 Wesleyan Health Centre, Kissy General 143 1236 Marie Stopes Maternity Unit General 144 1237 Marie Stopes Clinic, Aberdeen Road General 145 1241 Rina Health Centre General 146 1242 SL Red Cross Clinic, Freetown General 147 1243 SOS Clinic General 148 1244 Well Woman Clinic, Banana Water General 149 1245 Women Health Care General 150 1246 Women in Crisis CHC, Kissy Dockyard General 151 1247 Choithram Hospital General 152 1248 Ralpha Maternity Hospital General 153 1249 Blessed Mokaba Clinic, Calaba Town General 154 1250 Blessed Mokaba Clinic, Sithorp Street General 155 1251 Chunes Traditional Hospital General 156 1252 CUPID Clinic General 157 1253 Curney Barnes General 158 1254 Dr Mansow Clinic General 159 1255 Dr. Robbin Coker's Clinic General 160 1256 East End Community Clinic General 161 1257 Elizmary Clinic General 162 1258 Family Clinic General 163 1259 Good Shepherd Clinic General 164 1260 Krim Clinic General 165 1261 Lacs Clinic General 166 1262 NACTIB New Life Hospital General 167 1263 Netland Nursing Home General 168 1264 Redeemers Clinic General 169 1265 Rejanic Clinic General 170 1266 SLPA Clinic General 171 1267 St John Clinic General 172 1268 Tepekah Clinic General 173 1269 Vinnel Clinic General 174 1270 West End Clinic/Hospital General 175 1271 Yangadie Memorial Health Centre General

March 2012 64 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 33: Health Facility Listing – Category of Community Health Centres, Sierra Leone 2011

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

1 6 Daru CHC CHC 2 15 Koindu CHC CHC 3 16 Bendu CHC CHC 4 25 Manowa CHC CHC 5 43 Ngiehun CHC CHC 6 51 Jojoima CHC CHC 7 56 Mobai CHC CHC 8 61 Laleihun Kovoma CHC CHC 9 70 Sandaru CHC CHC 10 75 Pendembu CHC CHC 11 78 Bandajuma Yawei CHC CHC 12 89 Kpandebu CHC CHC 13 95 Dodo CHC CHC 14 99 Joru CHC CHC 15 109 Mondema CHC CHC 16 112 Tungie CHC CHC 17 113 Baoma Oil Mill CHC CHC 18 116 Levuma CHC CHC 19 118 Baoma CHC CHC 20 126 Foindu CHC CHC 21 133 Lowoma CHC CHC 22 141 Tongo Field CHC CHC 23 142 Weima CHC CHC 24 145 Bendu Mameima CHC CHC 25 150 Sendumei CHC CHC 26 159 Hanga CHC CHC 27 170 Largo CHC CHC 28 172 Nekabu CHC CHC 29 179 Talia CHC CHC 30 193 Boajibu CHC CHC 31 196 Blama CHC CHC 32 201 Tobanda CHC CHC 33 204 Gorahun CHC CHC 34 207 Ngegbwema CHC CHC 35 209 Baama CHC CHC

March 2012 65 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 33: Health Facility Listing – Category of Community Health Centres, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

36 217 Njagbama Fiama CHC CHC 37 220 Gandorhun CHC CHC 38 239 Kangama CHC CHC 39 245 Tombodu CHC CHC 40 265 Yengema CHC CHC 41 269 Jaiama Sewafe CHC CHC 42 275 Kayima CHC CHC 43 282 Yormandu CHC CHC 44 286 Kainkordu CHC CHC 45 291 Koaquima CHC CHC 46 304 Kamabai CHC CHC 47 318 Rokonta CHC CHC 48 322 Loreto Clinic CHC 49 329 Gbanti CHC CHC 50 333 Kamaranka CHC CHC 51 337 Kalangba CHC CHC 52 342 Tambiama CHC CHC 53 343 Gbendembu Wesleyan Health Centre CHC 54 344 Batkanu CHC CHC 55 350 Kagbere CHC CHC 56 360 Masongbo CHC CHC 57 372 Mapaki CHC CHC 58 375 Binkolo CHC CHC 59 384 Kamalo CHC CHC 60 389 Mabunduka CHC CHC 61 391 Mateboi CHC CHC 62 393 Rokulan CHC CHC 63 401 Kathanta Yimbor CHC CHC 64 403 Fintonia CHC CHC 65 411 Kukuna CHC CHC 66 415 Mafaray CHC CHC 67 428 Rokupr CHC CHC 68 437 Mambolo CHC CHC 69 443 Roseba Health Centre CHC 70 445 Barmoi Munu CHC CHC

March 2012 66 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 33: Health Facility Listing – Category of Community Health Centres, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

71 452 Mafufuneh CHC CHC 72 454 Mapotolo CHC CHC 73 459 Yelliboya CHC CHC 74 462 Kamassassa CHC CHC 75 476 Sinkunia CHC CHC 76 483 Kondembaia CHC CHC 77 486 Dogoloya CHC CHC 78 491 Fadugu CHC CHC 79 496 Bendugu CHC CHC 80 508 Kurubonla CHC CHC 81 515 Firawa CHC CHC 82 519 Yiffin CHC CHC 83 528 Falaba CHC CHC 84 533 Bafodia CHC CHC 85 545 Barmoi CHC CHC 86 551 Mange CHC CHC 87 559 Kamsando CHC CHC 88 566 Gbinti CHC CHC 89 572 Air Port Community Health Centre, Lungi CHC 90 573 Conakry Dee CHC CHC 91 579 Mahera CHC CHC 92 581 Targrin CHC CHC 93 598 Masiaka CHC CHC 94 605 Babara CHC CHC 95 620 Petifu CHC CHC 96 621 Gbere Junction CHC CHC 97 635 Lunsar CHC CHC 98 645 Masimera CHC CHC 99 651 Nonkoba Health Centre CHC 100 656 Sendugu CHC CHC 101 658 Malekuray CHC CHC 102 671 Yele CHC CHC 103 677 Bumbuna CHC CHC 104 682 Mabang CHC CHC 105 697 Makali CHC CHC

March 2012 67 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 33: Health Facility Listing – Category of Community Health Centres, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

106 708 Masingbi CHC CHC 107 717 Bendugu CHC CHC 108 728 Matotoka CHC CHC 109 734 Hinistas Mile 91 CHC CHC 110 758 Ngelehun CHC CHC 111 762 Jimmy CHC CHC 112 771 Ngalu CHC CHC 113 777 Jembe CHC CHC 114 785 Yamandu CHC CHC 115 786 St Luke's CHC, Gerihun CHC 116 788 Bumpeh CHC CHC 117 793 Ngolahun CHC CHC 118 800 Gbaiima CHC CHC 119 803 Koribondo CHC CHC 120 819 Manjama CHC CHC 121 824 Needy CHC CHC 122 825 New Police Barracks CHC CHC 123 826 Paramedical CHC (School of Community Health Sciences) CHC 124 829 Yemoh Town CHC CHC 125 855 Njala CHC CHC 126 863 Sumbuya CHC CHC 127 868 Nengbema CHC CHC 128 870 Sahn CHC CHC 129 871 Damballa CHC CHC 130 873 Gondama CHC CHC 131 878 Tikonko CHC CHC 132 879 Baomahun CHC CHC 133 884 Mongere CHC CHC 134 889 Wonde Gboyama CHC CHC 135 891 Bendu CHC CHC 136 895 Madina CHC CHC 137 900 Tissana CHC CHC 138 902 Gbamgbama CHC CHC 139 905 Moriba Town CHC CHC

March 2012 68 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 33: Health Facility Listing – Category of Community Health Centres, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

140 923 Motuo CHC CHC 141 925 Benduma CHC CHC 142 930 Gbap CHC CHC 143 944 Tihun CHC CHC 144 947 Talia CHC CHC 145 953 Sembehun CHC CHC 146 960 Rotifunk CHC CHC 147 967 Mano CHC CHC 148 971 Gandorhun CHC CHC 149 974 Moyamba Junction CHC CHC 150 986 Shenge CHC CHC 151 998 Kangahun CHC CHC 152 1003 Senehun CHC CHC 153 1004 Bauya CHC CHC 154 1015 Njala University Clinic CHC 155 1016 Taiama CHC CHC 156 1021 Njama CHC CHC 157 1023 Gbangbatoke CHC CHC 158 1025 Mokanji CHC CHC 159 1030 Bradford CHC CHC 160 1039 Bomotoke CHC CHC 161 1053 Potoru CHC CHC 162 1059 Bumpeh Perri CHC CHC 163 1072 Gbondapi CHC CHC 164 1086 Zimmi CHC CHC 165 1088 Sahn CHC CHC 166 1092 Mano Gbonjieima CHC CHC 167 1098 Futa CHC CHC 168 1100 Fairo CHC CHC 169 1102 Jendema CHC CHC 170 1108 Bandajuma CHC CHC 171 1109 Geoma Jagor CHC CHC 172 1113 Karlu CHC CHC 173 1122 Gloucester CHC CHC 174 1123 Goderich Health Centre CHC

March 2012 69 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 33: Health Facility Listing – Category of Community Health Centres, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

175 1126 Hastings Health Centre CHC 176 1130 Lakka/Ogoo Farm CHC CHC 177 1140 Milton Margai CHC CHC 178 1141 Newton CHC CHC 179 1142 Regent Health Centre CHC 180 1144 Songo CHC CHC 181 1149 Tombo Health Centre CHC 182 1150 Waterloo Community Health Centre CHC 183 1151 York Health Centre CHC 184 1169 Calaba Town CHC CHC 185 1170 Cline Town Health Centre CHC 186 1171 College of Medicine Clinic CHC 187 1173 Fourah Bay College Clinic CHC 188 1174 George Brook Health Centre CHC 189 1175 Ginger Hall Health Centre CHC 190 1176 Grassfield CHC CHC 191 1177 Grey Bush CHC CHC 192 1181 Kissy Health Centre CHC 193 1182 Kroo Bay CHC CHC 194 1183 Kuntolo CHC CHC 195 1188 Moyiba CHC CHC 196 1189 Murray Town CHC CHC 197 1194 Ross Road Health Centre CHC 198 1197 St. Joseph Fathers CHC CHC 199 1201 Wellington Health Centre CHC 200 1202 Wilberforce CHC CHC 201 1204 Youyi Building Clinic CHC

March 2012 70 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 34: Health Facility Listing – Category of Community Health Posts, Sierra Leone 2011

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

1 2 Baiwalla CHP CHP 2 3 Nagbena CHP CHP 3 4 Sienga CHP CHP 4 7 Kambama CHP CHP 5 9 Nyeama CHP CHP 6 10 Pellie CHP CHP 7 11 Pewama CHP CHP 8 12 Dia CHP CHP 9 13 Bayama CHP CHP 10 14 Kangama CHP CHP 11 18 Gbandiwulo CHP CHP 12 20 Sandia (Kissi Tongi) CHP CHP 13 22 Gbahama CHP CHP 14 24 Mamboma CHP CHP 15 26 Bunumbu CHP CHP 16 28 Peje Baoma CHP CHP 17 29 Pejewa CHC CHP 18 32 Baoma Luawa CHP CHP 19 33 Dodo Kortuma CHP CHP 20 34 Gbalahun CHP CHP 21 35 Gbeworbu Gao CHP CHP 22 38 Konjo CHP CHP 23 40 Mano Sewallu CHP CHP 24 42 Morfindor CHP CHP 25 44 Nyandehun CHP CHP 26 45 Sandialu CHP CHP 27 46 Sengema CHP CHP 28 49 Bumpe CHP CHP 29 50 Fobu CHP CHP 30 54 Baiima CHP CHP 31 55 Levuma CHP CHP 32 58 Bandajuma Kpolihun CHP CHP 33 62 Mano Menima CHP CHP 34 68 Kono Bendu CHP CHP 35 69 Lalehun CHP CHP

March 2012 71 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 34: Health Facility Listing – Category of Community Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

36 71 Woroma CHP CHP 37 72 Bomaru CHP CHP 38 74 Mendekelema CHP CHP 39 79 Bendu CHP CHP 40 80 Kwellu Ngieya CHP CHP 41 81 Malema CHP CHP 42 86 Geima CHP CHP 43 87 Konjo CHP CHP 44 90 Loppa CHP CHP 45 94 Tokpombu CHP CHP 46 97 Kundorma CHP CHP 47 98 Mbowohun CHP CHP 48 100 Kokoru CHP CHP 49 101 Mendekelema CHP CHP 50 106 Venima CHP CHP 51 107 Bambara Kaima CHP CHP 52 108 Konta CHP CHP 53 110 Ngiegboiya CHP CHP 54 111 Punduru CHP CHP 55 120 Jui CHP CHP 56 122 Serabu CHP CHP 57 124 Yabaima CHP CHP 58 130 Kornia Kpindema CHP CHP 59 132 Kpetema CHP CHP 60 137 Saama CHP CHP 61 147 Ngeihun Konjo CHP CHP 62 149 Gandorhun CHP CHP 63 151 Nomo Faama CHP CHP 64 152 Bambawolo CHP CHP 65 160 Jormu CHP CHP 66 184 School Health Clinic CHP 67 197 Doujou CHP CHP 68 202 Belebu CHP CHP 69 203 Fayeima CHP CHP 70 206 Mano Njeigbla CHP CHP

March 2012 72 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 34: Health Facility Listing – Category of Community Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

71 208 Ngeiwahun CHP CHP 72 211 Faala CHP CHP 73 242 Peyima CHP CHP 74 247 Gbonagongor CHP CHP 75 248 Komba Yendeh CHP CHP 76 254 Sambaya CHP CHP 77 258 Motema CHP CHP 78 260 Njagbwema CHP CHP 79 261 Njala CHP CHP 80 270 Massabendu CHP CHP 81 271 Ngo Town CHP CHP 82 273 Sandia CHP CHP 83 280 Tefeya CHP CHP 84 281 Wordu CHP CHP 85 289 Baiama CHP CHP 86 297 Kondewakor CHP CHP 87 298 Kpetema CHP CHP 88 302 Kagbaneh CHP CHP 89 316 Pate Bana CHP CHP 90 319 Tonko Maternity Clinic CHP 91 331 Gbonkobana CHP CHP 92 332 Gboronoh CHP CHP 93 334 Kambia CHP CHP 94 336 Royeama CHP CHP 95 338 Kortohun CHP CHP 96 339 Madina Loko CHP CHP 97 345 Gbonkonka CHP CHP 98 346 Kaimunday CHP CHP 99 349 Hunduwa CHP CHP 100 355 Kunsho CHP CHP 101 364 Stocco CHP CHP 102 371 Makolor CHP CHP 103 385 Laiya CHP CHP 104 386 Madina Fullah CHP CHP 105 398 Kamasankorie CHP CHP

March 2012 73 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 34: Health Facility Listing – Category of Community Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

106 399 Kamawornie CHP CHP 107 404 Samaya CHP CHP 108 405 Sanya CHP CHP 109 410 Konta CHP CHP 110 414 Gbalamuya CHP CHP 111 419 Barmoi Luma CHP CHP 112 421 Gbonkomaria CHP CHP 113 442 Tombo Walla CHP CHP 114 448 Kawula CHP CHP 115 451 Kychum CHP CHP 116 456 Rokai CHP CHP 117 457 Rosinor CHP CHP 118 465 Madina CHP CHP 119 467 Nuema CHP CHP 120 470 Timpo CHP CHP 121 474 Gbindi CHP CHP 122 479 Dalakuru CHP CHP 123 487 Gbentu CHP CHP 124 490 Musaia CHP CHP 125 505 Bandapirie CHP CHP 126 523 Kamadu Sokralla CHP CHP 127 526 Yiraia CHP CHP 128 540 Yataya CHP CHP 129 547 Kagbanthama CHP CHP 130 553 Minthomore CHP CHP 131 570 Rogballan Dibia CHP CHP 132 582 Yongoro CHP CHP 133 601 Mile 38 CHP CHP 134 602 Rofoindu CHP CHP 135 606 Bailor CHP CHP 136 609 Gbinti-Wallah CHP CHP 137 610 Kagbulor CHP CHP 138 613 Konta-Wallah CHP CHP 139 614 Mana II CHP CHP 140 619 Pepel CHP CHP

March 2012 74 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 34: Health Facility Listing – Category of Community Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

141 631 New Maforkie CHP CHP 142 653 Kantia CHP CHP 143 654 Konneh CHP CHP 144 657 Kambia Makama CHP CHP 145 663 Makonkorie CHP CHP 146 664 Mansumana CHP CHP 147 667 Mayepoh CHP CHP 148 672 Mabontor CHP CHP 149 674 Masumbrie CHP CHP 150 686 Mabom CHP CHP 151 706 Mamanso Sanka CHP CHP 152 730 Bakeloko CHP CHP 153 748 Rochem Kamandao CHP CHP 154 751 Rorocks CHP CHP 155 766 Niagorehun CHP CHP 156 772 Baoma Station CHP CHP 157 774 Faabu CHP CHP 158 783 Tugbebu CHP CHP 159 790 Kpetema CHP CHP 160 796 Taninahun CHP CHP 161 806 Mano-Jaiama CHP CHP 162 807 Niayahun CHP CHP 163 808 Telu CHP CHP 164 818 Maguama CHP CHP 165 841 Fatibra CHP CHP 166 856 Teibor CHP CHP 167 858 Feiba CHP CHP 168 861 Kpetewoma CHP CHP 169 877 Sembehun 17 CHP CHP 170 880 Foya CHP CHP 171 881 Grima CHP CHP 172 893 Taigbeh CHP CHP 173 894 Maami CHP CHP 174 898 Torma Bum CHP CHP 175 899 Mboma CHP CHP

March 2012 75 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 34: Health Facility Listing – Category of Community Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

176 901 Gbamgbaia CHP CHP 177 904 Mogbwemo CHP CHP 178 909 Gambia CHP CHP 179 912 Kabati CHP CHP 180 921 Gbongeh CHP CHP 181 926 Tei CHP CHP 182 927 Topan CHP CHP 183 928 Baoma Kpenge CHP CHP 184 929 Gbamami CHP CHP 185 935 Mbokie CHP CHP 186 950 Kawaya CHP CHP 187 951 Mokassie CHP CHP 188 955 Belentin CHP CHP 189 956 Bumpeh River CHP CHP 190 959 Moyeamoh CHP CHP 191 968 Mogbasske CHP CHP 192 977 Rotawa CHP CHP 193 978 Bumpetoke CHP CHP 194 979 Mokainsumana CHP CHP 195 980 Mokandor CHP CHP 196 988 Youndu CHP CHP 197 995 Salina CHP CHP 198 1001 Gondama CHP CHP 199 1007 Magbenka CHP CHP 200 1010 Fogbo CHP CHP 201 1013 Konda CHP CHP 202 1026 Mokotawa CHP CHP 203 1027 Mosenessie Junction CHP CHP 204 1031 Ferry CHP CHP 205 1038 Suen CHP CHP 206 1042 Mosanda CHP CHP 207 1049 Bandasuma CHP CHP 208 1052 Njaluahun CHP CHP 209 1058 Blama Massaquoi CHP CHP 210 1060 Falaba CHP CHP

March 2012 76 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 34: Health Facility Listing – Category of Community Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

211 1061 Fonikor CHP CHP 212 1069 Sumbuya Bessima CHP CHP 213 1070 Bomu Samba CHP CHP 214 1071 Dandabu CHP CHP 215 1082 Gbaa CHP CHP 216 1085 Gofor CHP CHP 217 1089 Sengema CHP CHP 218 1090 Taninahun CHP CHP 219 1101 Fanima CHP CHP 220 1106 Sulima CHP CHP 221 1115 Adonkia CHP CHP 222 1116 Banana Island CHP CHP 223 1117 Campbell Town CHP CHP 224 1118 Charlotte CHP CHP 225 1128 Kent CHP CHP 226 1129 Kissy Town CHP CHP 227 1131 Leicester Health Centre CHP 228 1132 Lumpa CHP CHP 229 1133 Mabureh CHP CHP 230 1138 Malambay CHP CHP 231 1139 Masorie CHP CHP 232 1161 Lion for Lion CHP CHP 233 1166 Allen Town CHP CHP 234 1167 Approved School CHP CHP 235 1179 Iscon CHP CHP 236 1196 School Clinic CHP 237 1238 Marie Stopes Clinic, Kissy CHP 238 1239 Marie Stopes Clinic, Waterloo Street CHP 239 1240 PPASL Clinic, Wesley Street CHP

March 2012 77 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

1 5 Bombohun MCHP MCHP 2 8 Kortuma MCHP MCHP 3 17 Dawa MCHP MCHP 4 19 Madopolahun MCHP MCHP 5 21 Voahun MCHP MCHP 6 23 Grima MCHP MCHP 7 27 Jokibu MCHP MCHP 8 31 Bandajuma Sinneh MCHP MCHP 9 36 Giema MCHP MCHP 10 37 Kailahun UFC/MCH Static MCHP 11 39 Kpandebu MCHP MCHP 12 41 Mende Buima MCHP MCHP 13 52 Madina MCHP MCHP 14 53 Njama MCHP MCHP 15 57 Yoyah MCHP MCHP 16 59 Follah MCHP MCHP 17 60 Gbeika MCHP MCHP 18 63 Niahun Gboyama MCHP MCHP 19 64 Nyadehun Ngovoihun MCHP MCHP 20 65 Pendembu njeiygbla MCHP MCHP 21 66 Nixon Hospital UFC/MCH Static MCHP 22 73 Jenneh MCHP MCHP 23 76 Siama MCHP MCHP 24 82 Massayeima MCHP MCHP 25 84 Diamei MCHP MCHP 26 85 Gao MCHP MCHP 27 88 Kornia MCHP MCHP 28 91 Majihun MCHP MCHP 29 92 Patama MCHP MCHP 30 93 Tawahun MCHP MCHP 31 96 Guala MCHP MCHP 32 102 Perrie MCHP MCHP 33 103 Sandaru MCHP MCHP 34 104 Sembehun (Gaura) MCHP MCHP 35 105 Tikonko MCHP MCHP

March 2012 78 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

36 114 Deima MCHP MCHP 37 115 Gbado MCHP MCHP 38 117 Sembehun MCHP MCHP 39 119 Bongor MCHP MCHP 40 121 Nyandehun MCHP MCHP 41 123 Woyama MCHP MCHP 42 125 Bomie MCHP MCHP 43 127 Kamboma MCHP MCHP 44 128 Komende Luyaima MCHP MCHP 45 129 Konjo MCHP MCHP 46 131 Kpandebu MCHP MCHP 47 134 Ngeihun MCHP MCHP 48 135 Njagbahun MCHP MCHP 49 136 Pelewahun MCHP MCHP 50 138 Sandayeima MCHP MCHP 51 139 Sembeima MCHP MCHP 52 140 Semewebu MCHP MCHP 53 144 Bendoma (Malegohun) MCHP MCHP 54 146 Helegombu MCHP MCHP 55 148 Bandawor MCHP MCHP 56 153 Burma 2 MCHP MCHP 57 154 Degbuama MCHP MCHP 58 155 Gbo-Kakajama 1 MCHP MCHP 59 156 Gbo-Kakajama 2 MCHP MCHP 60 157 Gbo-Lambayama 1 MCHP MCHP 61 158 Gbo-Lambayama 2 MCHP MCHP 62 161 Kenema MCH Static MCHP 63 162 Komende MCHP MCHP 64 163 Konabu MCHP MCHP 65 164 Kordebotehun MCHP MCHP 66 165 Koyagbema MCHP MCHP 67 166 Kpayama 1 MCHP MCHP 68 167 Kpayama 2 MCHP MCHP 69 168 Kpetema MCHP MCHP 70 169 Lango Town MCHP MCHP

March 2012 79 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

71 171 Massahun MCHP MCHP 72 173 Ngelehun MCHP MCHP 73 174 Niahun Buima MCHP MCHP 74 175 Nyandeyaima MCHP MCHP 75 176 Panderu MCHP MCHP 76 177 Potehun MCHP MCHP 77 178 Samai Town MCHP MCHP 78 180 Tokpombu MCHP MCHP 79 181 Vaahun MCHP MCHP 80 194 Gbangeima MCHP MCHP 81 198 Gelehun MCHP MCHP 82 199 London (Blama) MCHP MCHP 83 200 Nyangbebo MCHP MCHP 84 205 Jao MCHP MCHP 85 210 Bambara MCHP MCHP 86 212 Gendema MCHP MCHP 87 214 Bandasuma Fiama MCHP MCHP 88 215 Borbodu MCHP MCHP 89 216 Kpatema MCHP MCHP 90 218 Yekior MCHP MCHP 91 219 Baoma MCHP MCHP 92 221 Kanekor MCHP MCHP 93 222 Sunga MCHP MCHP 94 223 Koardu MCHP MCHP 95 224 Sindadu MCHP MCHP 96 225 Boroma MCHP MCHP 97 226 Gbangadu MCHP MCHP 98 227 Koakor MCHP MCHP 99 228 Koeyor MCHP MCHP 100 229 Koidu MCH Static MCHP 101 230 Quidadu MCHP MCHP 102 231 Small Sefadu MCHP MCHP 103 238 Bunabu MCHP MCHP 104 240 Njagbwema MCHP MCHP 105 241 Torkpumbu MCHP MCHP

March 2012 80 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

106 243 Samiquidu MCHP MCHP 107 244 Sukudu MCHP MCHP 108 246 Foakor MCHP MCHP 109 249 Kongoifeh MCHP MCHP 110 250 Kundundu MCHP MCHP 111 251 Saiama MCHP MCHP 112 252 Kamiendor MCHP MCHP 113 253 Koindu-kuntey MCHP MCHP 114 255 Bumpeh MCHP MCHP 115 256 Gondama MCHP MCHP 116 257 Mansundu MCHP MCHP 117 259 Ngaiya MCHP MCHP 118 262 Seidu MCHP MCHP 119 263 Senjekoro MCHP MCHP 120 264 Tongorma MCHP MCHP 121 268 Condama MCHP MCHP 122 272 Peya MCHP MCHP 123 274 Bangambaya MCHP MCHP 124 276 Kochero MCHP MCHP 125 277 Kondeya MCHP MCHP 126 278 Masundu MCHP MCHP 127 279 Samandu MCHP MCHP 128 283 Bandusuma MCHP MCHP 129 284 Feuror MCHP MCHP 130 285 Gbamandu MCHP MCHP 131 287 Manjama MCHP MCHP 132 288 Sukudu Soa MCHP MCHP 133 290 Kensay MCHP MCHP 134 292 Swarray Town MCHP MCHP 135 293 Tongoro MCHP MCHP 136 294 Woama MCHP MCHP 137 300 Bumban MCHP MCHP 138 301 Bumbanday MCHP MCHP 139 303 Kagbankona MCHP MCHP 140 305 Kamasikie MCHP MCHP

March 2012 81 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

141 306 Kanikay MCHP MCHP 142 307 Karina MCHP MCHP 143 308 Kayongoro MCHP MCHP 144 309 Manjoro MCHP MCHP 145 310 Fullah Town II MCHP MCHP 146 311 Mabolleh MCHP MCHP 147 312 Maforay (B. Sebora) MCHP MCHP 148 313 Makama MCHP MCHP 149 314 Makump Bana MCHP MCHP 150 315 Masory MCHP MCHP 151 317 Robat MCHP MCHP 152 330 Gbenkfay MCHP MCHP 153 335 Makaiba MCHP MCHP 154 340 Maharie MCHP MCHP 155 341 Mamaka MCHP MCHP 156 347 Magbaingba MCHP MCHP 157 348 Matoto MCHP MCHP 158 351 Mambiama MCHP MCHP 159 352 Fullah Town I MCHP MCHP 160 353 Kerefay Loko MCHP MCHP 161 354 Kolisokor MCHP MCHP 162 356 Mabayo MCHP MCHP 163 357 Magbaikoli MCHP MCHP 164 358 Makarie MCHP MCHP 165 359 Mangay Loko MCHP MCHP 166 361 Masuba MCHP MCHP 167 362 Panlap MCHP MCHP 168 363 Puntung MCHP MCHP 169 365 Tonkomba MCHP MCHP 170 366 Yankasa MCHP MCHP 171 369 Kathanta Bana MCHP MCHP 172 370 Makeni-Lol MCHP MCHP 173 373 Masanbopi MCHP MCHP 174 374 Masingbi-Lol MCHP MCHP 175 376 Kabombeh MCHP MCHP

March 2012 82 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

176 377 Kabonka MCHP MCHP 177 378 Kagbo MCHP MCHP 178 379 Kapethe MCHP MCHP 179 380 Kayasie MCHP MCHP 180 381 Mabonkani MCHP MCHP 181 382 Maselleh MCHP MCHP 182 383 Masongbo Limba MCHP MCHP 183 387 Maharibo MCHP MCHP 184 388 Rothatha MCHP MCHP 185 390 Manack MCHP MCHP 186 392 Rogbin MCHP MCHP 187 394 Kabba Ferry MCHP MCHP 188 395 Kagboray MCHP MCHP 189 396 Kamabaio MCHP MCHP 190 397 Kamakwie MCHP MCHP 191 400 Kaponkie MCHP MCHP 192 407 Barakuya MCHP MCHP 193 408 Gbolon MCHP MCHP 194 409 Kanku-Bramaia MCHP MCHP 195 412 Shekaiah MCHP MCHP 196 413 Fodaya MCHP MCHP 197 416 Magbengbeh MCHP MCHP 198 417 Tawuya MCHP MCHP 199 418 Woreh MCHP MCHP 200 420 Dibia MCHP MCHP 201 422 Kamba MCHP MCHP 202 423 Kambia MCH Static MCHP 203 424 Magbety MCHP MCHP 204 425 Mathurane MCHP MCHP 205 426 Menicurve MCHP MCHP 206 427 Modia MCHP MCHP 207 429 Senthai MCHP MCHP 208 430 Wulla Thenkle MCHP MCHP 209 434 Kalainkay MCHP MCHP 210 435 Kortimoh MCHP MCHP

March 2012 83 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

211 436 Macoth MCHP MCHP 212 438 Mayaki MCHP MCHP 213 439 Rokain Bana MCHP MCHP 214 440 Rokel MCHP MCHP 215 441 Romando MCHP MCHP 216 444 Banka Makuloh MCHP MCHP 217 446 Gbalathallan MCHP MCHP 218 447 Kania MCHP MCHP 219 449 Bapuya MCHP MCHP 220 450 Koya MCHP MCHP 221 453 Mange Bissan MCHP MCHP 222 455 Moribaya MCHP MCHP 223 458 Sorie Bolomia MCHP MCHP 224 461 Kamagbew MCHP MCHP 225 463 Kasoria MCHP MCHP 226 464 Katherie MCHP MCHP 227 466 Masselleh MCHP MCHP 228 468 Samaya MCHP MCHP 229 469 Sella Kafta MCHP MCHP 230 473 Fulamansa MCHP MCHP 231 475 Manna MCHP MCHP 232 477 Sonkoya MCHP MCHP 233 478 Badala MCHP MCHP 234 480 Foria MCHP MCHP 235 481 Kamaron MCHP MCHP 236 482 Kania MCHP MCHP 237 484 Lengekoro MCHP MCHP 238 485 Yara MCHP MCHP 239 488 Hamdalai MCHP MCHP 240 489 Kamba Mamudia MCHP MCHP 241 492 Kagbasia MCHP MCHP 242 493 Kasanikoro MCHP MCHP 243 494 Madina Gbonghobor MCHP MCHP 244 495 Sawuria MCHP MCHP 245 497 Gberifeh MCHP MCHP

March 2012 84 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

246 498 Kamaron MCHP MCHP 247 499 Kombili MCHP MCHP 248 500 Mansadu MCHP MCHP 249 501 Serekolia MCHP MCHP 250 502 Seria MCHP MCHP 251 503 Tambaiabalia MCHP MCHP 252 504 Walia MCHP MCHP 253 506 Bumbukoro MCHP MCHP 254 507 Dulukoro MCHP MCHP 255 509 Masofinia MCHP MCHP 256 510 Porpon MCHP MCHP 257 511 Yarwadu MCHP MCHP 258 512 Alkalia MCHP MCHP 259 513 Bandakarfaia MCHP MCHP 260 514 Fankoya MCHP MCHP 261 516 Kruton MCHP MCHP 262 517 Kumala MCHP MCHP 263 518 Sumbaria MCHP MCHP 264 520 Bambukoro MCHP MCHP 265 521 Dankawalie MCHP MCHP 266 522 Gbenikoro MCHP MCHP 267 524 Koinadugu II MCHP MCHP 268 525 Kondeya MCHP MCHP 269 529 Ganya MCHP MCHP 270 530 Gberia Timbakor MCHP MCHP 271 531 Kaliyereh MCHP MCHP 272 532 Koindu Kura MCHP MCHP 273 534 Kadanso MCHP MCHP 274 535 Kakoya MCHP MCHP 275 536 Thellia MCHP MCHP 276 537 Heremakono MCHP MCHP 277 538 Kabala MCH Static MCHP 278 539 Senekedugu MCHP MCHP 279 546 Bureh MCHP MCHP 280 548 Kalangba MCHP MCHP

March 2012 85 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

281 549 Kawengha MCHP MCHP 282 550 Mabain MCHP MCHP 283 552 Masseseh MCHP MCHP 284 554 Rogballan MCHP MCHP 285 555 Romeni MCHP MCHP 286 556 Bureh Mende MCHP MCHP 287 557 Foredugu MCHP MCHP 288 558 Gbomsamba MCHP MCHP 289 560 Madina MCHP MCHP 290 561 Mafoifie MCHP MCHP 291 562 Manumtheneh MCHP MCHP 292 563 Masamboi MCHP MCHP 293 564 Rosint Buya MCHP MCHP 294 565 Wereh-bana MCHP MCHP 295 567 Gbombana MCHP MCHP 296 568 Kareneh MCHP MCHP 297 569 Maborognor MCHP MCHP 298 571 Rokutolor MCHP MCHP 299 574 Gbaneh-Bana MCHP MCHP 300 575 Gbaneh-Lol MCHP MCHP 301 576 Kasongha MCHP MCHP 302 577 Lungi MCH Static MCHP 303 578 Lungi Town MCHP MCHP 304 580 Mamankie MCHP MCHP 305 589 Kissy Koya MCHP MCHP 306 590 Komrabai Ngalla MCHP MCHP 307 591 Kuranko MCHP MCHP 308 592 Mabora MCHP MCHP 309 593 Magbeni MCHP MCHP 310 594 Makalie MCHP MCHP 311 595 Makarankay MCHP MCHP 312 596 Makiteh MCHP MCHP 313 597 Malenki MCHP MCHP 314 599 Masumana MCHP MCHP 315 600 Mawoma MCHP MCHP

March 2012 86 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

316 603 Sumbuya MCHP MCHP 317 604 Warima MCHP MCHP 318 607 Benkia MCHP MCHP 319 608 Bundulai MCHP MCHP 320 611 Kalangba MCHP MCHP 321 612 Katongha MCHP MCHP 322 615 Mapillah MCHP MCHP 323 616 Mathen MCHP MCHP 324 617 Menika MCHP MCHP 325 618 Musaia MCHP MCHP 326 622 Gbonkoh Kareneh MCHP MCHP 327 623 Lower Mafoimara MCHP MCHP 328 624 Mabonie MCHP MCHP 329 625 Magbaingbera MCHP MCHP 330 626 Maforay MCHP MCHP 331 627 Makaba MCHP MCHP 332 628 Malal MCHP MCHP 333 629 Mapaum MCHP MCHP 334 630 Maronko MCHP MCHP 335 632 Port Loko UFC/MCH Static MCHP 336 636 Magbele MCHP MCHP 337 637 Magbil MCHP MCHP 338 638 Makabo MCHP MCHP 339 639 Mamusa MCHP MCHP 340 640 Rolemray MCHP MCHP 341 642 Katick MCHP MCHP 342 643 Konta-Line MCHP MCHP 343 644 Mamaligie MCHP MCHP 344 646 Mayola MCHP MCHP 345 647 Mayombo MCHP MCHP 346 648 Rofutha MCHP MCHP 347 649 Rokel (Masimera) MCHP MCHP 348 650 Royeben MCHP MCHP 349 652 Gbagbodo MCHP MCHP 350 655 Magbolonthor MCHP MCHP

March 2012 87 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

351 659 Maron MCHP MCHP 352 660 Robaka MCHP MCHP 353 661 Rogbaneh MCHP MCHP 354 665 Maraka MCHP MCHP 355 666 Mathamp MCHP MCHP 356 668 Petifu Mayepoh MCHP MCHP 357 669 Warema MCHP MCHP 358 670 Yeben MCHP MCHP 359 673 Makonthandae MCHP MCHP 360 675 Mayassoh MCHP MCHP 361 676 Bassia MCHP MCHP 362 678 Kamasaypana MCHP MCHP 363 679 Kathombo MCHP MCHP 364 680 Kemedugu MCHP MCHP 365 681 Komrabai Station MCHP MCHP 366 683 Mamanso Kafla MCHP MCHP 367 684 Mathinkalol MCHP MCHP 368 685 Mabai MCHP MCHP 369 687 Maborie MCHP MCHP 370 688 Magbass MCHP MCHP 371 689 Magburaka MCH Static MCHP 372 690 Malone MCHP MCHP 373 691 Mamuntha MCHP MCHP 374 692 Masanga UFC/MCH Static MCHP 375 693 Masoko MCHP MCHP 376 694 Mayossoh MCHP MCHP 377 698 Makoni Line MCHP MCHP 378 699 Mapamurie MCHP MCHP 379 700 Masaba MCHP MCHP 380 701 Wonkibor MCHP MCHP 381 702 Fotaneh Junction MCHP MCHP 382 703 Fothaneh Bana MCHP MCHP 383 704 Mabineh MCHP MCHP 384 705 Magbanabom MCHP MCHP 385 707 Masaika MCHP MCHP

March 2012 88 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

386 709 Matholey MCHP MCHP 387 710 Petifu Line MCHP MCHP 388 711 Kiampkakolo MCHP MCHP 389 712 Makoba Bana MCHP MCHP 390 713 Manewa MCHP MCHP 391 714 Mara MCHP MCHP 392 715 Robina MCHP MCHP 393 716 Rochen Malal MCHP MCHP 394 718 Dankawalia MCHP MCHP 395 719 Kholifaga MCHP MCHP 396 720 Kunya MCHP MCHP 397 721 Ninkikoro MCHP MCHP 398 722 Makona MCHP MCHP 399 723 Makrugbeh MCHP MCHP 400 724 Mange Bana M CHP MCHP 401 725 Masankoro MCHP MCHP 402 726 Mathonkara MCHP MCHP 403 727 Mathufulie MCHP MCHP 404 729 Rosengbeh MCHP MCHP 405 731 Bath Bana MCHP MCHP 406 732 Bonkababay MCHP MCHP 407 733 Foindu MCHP MCHP 408 735 Kumrabai Yoni MCHP MCHP 409 736 Magbaesia MCHP MCHP 410 737 Magbaft MCHP MCHP 411 738 Magbasia Bana MCHP MCHP 412 739 Magboki Rd. Mile 91 MCHP MCHP 413 740 Makelleh MCHP MCHP 414 741 Makeni-Rokfullah MCHP MCHP 415 742 Makondu MCHP MCHP 416 743 Mamaka MCHP MCHP 417 744 Mathoir MCHP MCHP 418 745 Mayogbor MCHP MCHP 419 746 Petifu Fulamansa MCHP MCHP 420 747 Robarie MCHP MCHP

March 2012 89 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

421 749 Rokimbi MCHP MCHP 422 750 Ronietta MCHP MCHP 423 752 Yonibana MCHP MCHP 424 759 Njandama MCHP MCHP 425 760 Bum Kaku MCHP MCHP 426 761 Gbangbalia MCHP MCHP 427 763 Kasse MCHP MCHP 428 764 Mano Yorgbo MCHP MCHP 429 765 Momajo MCHP MCHP 430 767 Barlie MCHP MCHP 431 768 Benduma MCHP MCHP 432 769 Kondiama MCHP MCHP 433 770 Mendewa MCHP MCHP 434 773 Blamawo MCHP MCHP 435 775 Gbahama MCHP MCHP 436 776 Golu MCHP MCHP 437 778 Jormu MCHP MCHP 438 779 Kigbai MCHP MCHP 439 780 Kpumbu MCHP MCHP 440 781 Mbundorbu MCHP MCHP 441 782 Pelewahun MCHP MCHP 442 784 Yakaji MCHP MCHP 443 787 Buma MCHP MCHP 444 789 Kaniya MCHP MCHP 445 791 Mokoba MCHP MCHP 446 792 Mokpende MCHP MCHP 447 794 Sahn Bumpe MCHP MCHP 448 795 Serabu UFC/MCH Static MCHP 449 797 Wallehun MCHP MCHP 450 798 Yengema MCHP MCHP 451 801 Sembehun Mamagewor MCHP MCHP 452 802 Gbaama MCHP MCHP 453 804 Lowoma MCHP MCHP 454 805 Mamboma MCHP MCHP 455 809 Bandajuma MCHP MCHP

March 2012 90| Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

456 810 Bo UFC/MCH Static MCHP 457 811 Fengehun MCHP MCHP 458 812 Fullawahun MCHP MCHP 459 813 Gbanja Town MCHP MCHP 460 814 Gbongoma MCHP MCHP 461 815 Gbotima MCHP MCHP 462 816 Harvest Time MCHP MCHP 463 817 Lyn Maternity MCHP MCHP 464 820 Massah Memorial Maternity MCHP MCHP 465 821 Mid Land MCHP MCHP 466 822 Nafaya Clinic & Maternity Home MCHP 467 823 Nduvuibu MCHP MCHP 468 827 Tengbewabu MCHP MCHP 469 828 UNIMUS MCHP MCHP 470 853 Komboya Gbauja MCHP MCHP 471 854 Niagorehun MCHP MCHP 472 857 Bontiwo MCHP MCHP 473 859 Hima MCHP MCHP 474 860 Karleh MCHP MCHP 475 862 Ngieyehun MCHP MCHP 476 864 Upper Saama MCHP MCHP 477 865 Yambama MCHP MCHP 478 867 Korbu MCHP MCHP 479 869 Ngogbebu MCHP MCHP 480 872 Gbangba MCHP MCHP 481 874 Griema MCHP MCHP 482 875 Kassama MCHP MCHP 483 876 Mattru on the Rail MCHP MCHP 484 882 Kpewama MCHP MCHP 485 883 Kpuabu MCHP MCHP 486 885 Ngolahun Jabaty MCHP MCHP 487 886 Bathurst MCHP MCHP 488 887 Fanima MCHP MCHP 489 888 Kambawama MCHP MCHP 490 892 Mindohun MCHP MCHP

March 2012 91 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

491 896 Ngessehun MCHP MCHP 492 897 Sogballeh MCHP MCHP 493 903 Jangalor MCHP MCHP 494 906 Victoria MCHP MCHP 495 907 Yargoi MCHP MCHP 496 910 Gbaninga MCHP MCHP 497 911 Junctionla MCHP MCHP 498 913 Komende MCHP MCHP 499 914 Mattru Jong MCHP MCHP 500 915 Mongerewa MCHP MCHP 501 916 Moyowa MCHP MCHP 502 917 Semabu MCHP MCHP 503 918 UBC Mattru U5C/MCH Static MCHP 504 922 Lawana MCHP MCHP 505 924 Senjehun MCHP MCHP 506 931 Minah MCHP MCHP 507 932 Bonthe UFC/MCH Static MCHP 508 933 Delken MCHP MCHP 509 934 Mania MCHP MCHP 510 936 Yomi MCHP MCHP 511 937 York Island MCHP MCHP 512 941 Kanga MCHP MCHP 513 942 Mandu MCHP MCHP 514 943 Ngueh MCHP MCHP 515 945 Mobefah MCHP MCHP 516 946 Senehun Gbloh MCHP MCHP 517 949 Benkeh MCHP MCHP 518 952 Mosenegor MCHP MCHP 519 954 Sembehunwo MCHP MCHP 520 957 Mokaiyegbeh MCHP MCHP 521 958 Motorbong MCHP MCHP 522 961 Sahun MCHP MCHP 523 962 Yenkissa MCHP MCHP 524 964 Babuibu Tommy MCHP MCHP 525 965 Kabaima MCHP MCHP

March 2012 92 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

526 966 Kenema Gbandoma MCHP MCHP 527 969 Taninihun Kapuima MCHP MCHP 528 970 Falaba MCHP MCHP 529 972 Mokellay MCHP MCHP 530 973 Mokorewa MCHP MCHP 531 975 Moyollo MCHP MCHP 532 976 Njagbahun MCHP MCHP 533 981 Mokobo MCHP MCHP 534 982 Mokongbetty MCHP MCHP 535 983 Mopailleh MCHP MCHP 536 984 Ngiehun MCHP MCHP 537 985 Plantain Island MCHP MCHP 538 987 Yorgbofore MCHP MCHP 539 989 Gbongeima MCHP MCHP 540 990 Komende MCHP MCHP 541 991 Korgbotuma MCHP MCHP 542 992 Levuma Kai MCHP MCHP 543 993 Moyamba MCH Static MCHP 544 994 Moyamba MCH Static II MCHP 545 996 Yoyema MCHP MCHP 546 1002 Mogbuama MCHP MCHP 547 1005 Lawana MCHP MCHP 548 1006 Levum Nyomeh MCHP MCHP 549 1008 Taninihun Mboka MCHP MCHP 550 1009 Bai Largo MCHP MCHP 551 1011 Gbuihun MCHP MCHP 552 1012 Juma MCHP MCHP 553 1014 Manjeihun MCHP MCHP 554 1017 Waima MCHP MCHP 555 1019 Bendu MCHP MCHP 556 1020 Mofombo MCHP MCHP 557 1022 Tabe MCHP MCHP 558 1024 Kanga MCHP MCHP 559 1028 Njagbahun L/Banta MCHP MCHP 560 1032 Mabang MCHP MCHP

March 2012 93 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

561 1033 Mobongisseh MCHP MCHP 562 1034 Mokorbu MCHP MCHP 563 1035 Motoni MCHP MCHP 564 1036 Motonkoh MCHP MCHP 565 1037 Rokolon MCHP MCHP 566 1040 Mokpanabom MCHP MCHP 567 1041 Mosagbe MCHP MCHP 568 1043 Gondama MCHP MCHP 569 1044 Modonkor MCHP MCHP 570 1045 Mogongbe MCHP MCHP 571 1046 Mokelle MCHP MCHP 572 1050 Gbengama MCHP MCHP 573 1051 Konia MCHP MCHP 574 1054 Saahun MCHP MCHP 575 1055 Tambeyama MCHP MCHP 576 1056 Taninahun MCHP MCHP 577 1057 Waiima MCHP MCHP 578 1062 Fuyehun MCHP MCHP 579 1063 Kowama MCHP MCHP 580 1064 Kpowubu MCHP MCHP 581 1065 Saama MCHP MCHP 582 1066 Liya MCHP MCHP 583 1067 Massam MCHP MCHP 584 1068 Saahun MCHP MCHP 585 1073 Gibena MCHP MCHP 586 1074 Mandema MCHP MCHP 587 1075 Pehala MCHP MCHP 588 1076 Pujehun MCH Static MCHP 589 1077 Salima MCHP MCHP 590 1078 Sawula MCHP MCHP 591 1079 Sorbeh Griema MCHP MCHP 592 1083 Ghahama MCHP MCHP 593 1084 Gissiwolo MCHP MCHP 594 1087 Nyandehun MCHP MCHP 595 1091 Bengani MCHP MCHP

March 2012 94 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

596 1093 Nyandehun (Mano Sakrim) MCHP MCHP 597 1094 Sebengu MCHP MCHP 598 1095 Bayama MCHP MCHP 599 1096 Vaama MCHP MCHP 600 1097 Bumbeh MCHP MCHP 601 1099 Pejewa MCHP MCHP 602 1103 Koijeh MCHP MCHP 603 1104 Malema 1 MCHP MCHP 604 1105 Sengama MCHP MCHP 605 1107 Wai MCHP MCHP 606 1110 Upper Komendeh MCHP MCHP 607 1111 Bangoma MCHP MCHP 608 1112 Borma MCHP MCHP 609 1119 Crossing MCHP MCHP 610 1120 Deep Eye water MCHP MCHP 611 1121 Fogbo MCHP MCHP 612 1124 Grafton MCHP MCHP 613 1125 Hamilton MCHP MCHP 614 1127 John Thorpe MCHP MCHP 615 1134 MacDonald MCHP MCHP 616 1135 Madaka MCHP MCHP 617 1136 Makobeh MCHP MCHP 618 1137 Makonkoay MCHP MCHP 619 1143 Rogbangbo MCHP MCHP 620 1145 Sussex MCHP MCHP 621 1146 Tasso Island MCHP MCHP 622 1147 Tissana MCHP MCHP 623 1148 Tokeh MCHP MCHP 624 1168 Benguema Grass Field MCHP MCHP 625 1172 EPI HQ Clinic MCHP 626 1178 Hill station MCHP MCHP 627 1180 Jenner Wright Clinic MCHP 628 1184 Looking Town MCHP MCHP 629 1185 Lumley Hospital UFC/MCH Static MCHP 630 1186 Mabella MCHP MCHP

March 2012 95 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

Table 35: Health Facility Listing – Category of Maternal and Child Health Posts, Sierra Leone 2011 (continued)

SERIAL No. NUMBER IN FACILITY NAME CATEGORY FACILITY LISTING

631 1187 Malama MCHP MCHP 632 1190 New London MCHP MCHP 633 1191 Ola During/PCMH UFC/MCH Static MCHP 634 1192 Philip St MCHP MCHP 635 1193 Quarry MCHP MCHP 636 1195 Scan Drive MCHP MCHP 637 1198 Susan's Bay MCHP MCHP 638 1199 Thompson Bay MCHP MCHP 639 1200 Well Body MCHP MCHP 640 1203 Wilberforce MCHP MCHP

March 2012 96 | Page UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES ANNEXES

REPUBLIC OF SIERRA LEONE

ANNEX A: SURVEY QUESTIONNAIRE

2011 AVAILABILITY OF MODERN CONTRACEPTIVES AND ESSENTIAL LIFE SAVING MATERNAL/RH MEDICINES IN SERVICE DELIVERY POINTS IN GPRHCS STREAM 1 COUNTRIES (WITH A MODULE ON TRACER DRUGS)

INFORMATION ABOUT THE INTERVIEW

Country ……………………………….…………………………………………………………...... …

Date of the Survey (year and month) 2011, …………………………….……......

Name of Respondent……………………………………...... … Signature …………………..…

Telephone No. ………………………………………...... … Date ………… October, 2011

Name of Interviewer ……………………………...... ………………………………………………

Date of Interview……………… October, 2011

Questionnaire checked and attested to be properly completed

Name of Supervisor………………………...... …….………………………………………..….

Signature ………………………………………… Date) ………… October, 2011

March 2012 97 | Page

No Tick only one one only Tick 2 ( opon) opon) Males Sterilisaon for 1Yes

ed) ed) be administered) administered) be No Tick only one one only Tick 2

( Females Females opon) 1Yes

Rural Rural

Mile Mile Urban 2 Urban No 4 Others (please specify…………………………) 4Othersspecify…………………………) (please Tick only one one only Tick 2

( opon) opon) 1Yes

Implants Sterilisaon for

Locaon (Name of Chiefdom)…………………………………………… (NameChiefdom)…………………………………………… of Locaon

Kilometers 2 Kilometers No Tick only one one only Tick 2 (

opon) opon) 1Yes

3 NGO 3NGO (If No, then items 009, 010 and; 013 to 017 should NOT 017 013should 009, to No,items then 010 (If and; (If No, then items 011 and 012 should NOT be administerNOTbe 012 should 011 No,items and then (If 2No TEMS I No Tick only one one only Tick 2 ( opon) opon)

Injectables Injectables IUDs 1Yes

t warehouse or store or facility where health supplies are stored and from which this health wherehealth this facility or health supplies store which or from warehouse areand t stored

s l DP TYPESERVICES AND PROVIDED DP l NAME, LOCATION AND DISTANCE NAME, AND LOCATION i S P l P a 2Private rO No 2No 2No Tick only one opon) one only Tick 2 ( 1Yes

ODERN CONTRACEPTIVE METHODS PROVIDED AT SDP AT PROVIDED METHODS CONTRACEPTIVE ODERN

plicabletoyour country) smod M ……… B) Locaon (Name of District)……………………………………… C) (Name of Locaon District)……………………………………… B) ……… ment ment … 1 Yes 1Yes no

C C 1 Yes 1Yes s (e.g. VCT, PMTCT, VCT, 1Yes ART, (e.g. s etc.)? e la e on of the health centre and the nearesthe centre the and health of on m No e Tick only one one only Tick cated in an urban area or a rural selement rural a area or urban an catedin per country’syour (as 1 classificaon; 2

( opon) opon) 1Yes F F Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES s m ickoponthe that is ap o T d

no UNFPA UNFPA Global Programme to Enhance Reproductive Health Commodity Security c elaM No 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health Tick only one one only Tick 2

( opon) opon) 1Yes

is Secondary level care SDPs/facilies/hospitals (or equivalent (or ) level care Secondary SDPs/facilies/hospitals Terary level care SDPs/facilies/hospitals (or equivalent) (or Terary level care SDPs/facilies/hospitals 2 3 centre receives its regular supplies? /____/ B) Please indicate distance Please B) indicate 1 in; centre/____/ receives regular supplies? its 1 Primary Level Care SDPs/facilies (or equivalent to country to equivalent 1Primary (or context) Level Care SDPs/facilies

D) Please indicate whether the SDP is lo is whether the SDP Please indicate D) Name of Service Delivery Point…………………………………………………………….………..…….……………… NameService Delivery of Point…………………………………………………………….………..…….………………

m provided to clients at this this at clients to provided O 01 e 004 DeliveryService Point( Typeof 006 services? planning family provide facility this Does 002 Selement)…………………………… (Name of A)Locaon 008 servic HIV/AIDS any provide facility this Does 005 1Govern Service Delivery Point: Managementof 007 deliveryservices? provide facility this Does 003 loca the between distance the is A)What

0 SN the contracepve method or each of the contracepves, eachof or tI provided to clients at this this clientsat to provided ServiceDelivery Point 010: NOT If serviceplease deliverypoint, reason. main the indicate

009: F please state whether it is is it whether state please

March 2012 98 | Page

Inventory Inventory No Tick only one one only Tick 2 Oxytocine taken, Medicine stock NOT in is 1Yes ( opon) taken, Medicine is in stock in is

Inventory Inventory No Tick only one one only Tick Metronidazole 2 opon) taken, is Medicine stockin stockNOT in

1Yes taken, is Medicine

(

Inventory Inventory No Tick only one one only Tick opon) opon) taken, is Medicine stockin stockNOT in 2 taken, is Medicine 1Yes ( Sulfate

Inventory Inventory

No Tick only one one only Tick in stock in taken, is Medicine 2 opon) NOT in stockNOT in 1Yes ( taken, Medicine is taken, is Medicine

Inventory taken, Inventory taken, No Tick only one one only Tick

NOT in is Medicine opon) 2 Medicine is in stock in is Medicine stock Ergometrine Ergometrine Iron/Folate 1Yes Magnesium (

aternal/RHMedicines Inventory taken, M Inventory taken, No Tick only one one only Tick

1Yes 2 opon) NOT in is Medicine Medicine is in stock in is Medicine stock (

INTERVIEWER VERIFICATION ITEMfor 011 Inventorytaken, Inventory taken, No Tick only one one only Tick

NOT in is Medicine Cefexime Cefexime 1Yes Clotrimazole 2 opon) stock in is Medicine stock (

AVAILABILITYHEALTH MEDICINESMATERNAL/REPRODUCTIVE OF Inventorytaken, Inventory taken, enicillin enicillin No Tick only one one only Tick

2 opon) ( NOT in is Medicine 1Yes Medicine is in stock in is Medicine stock P

Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES Inventory Inventory No Tick only one one only Tick

1Yes in stock in 2 opon) is taken, Medicine ( taken, Medicine is is taken, Medicine stock NOTin

UNFPA UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health

Inventorytaken, Inventorytaken, No Tick only one one only Tick 1Yes Amoxicillin Azithromycine Benzathine

2 opon) NOT in is Medicine (

Medicine is in stock in Medicineis stock tem 011, i in this this in in this this in

Currently the medicine is is medicine the ealth facility facility ealth or each of the of each or If 011: F not currently the indicate please reason. main is is maternal/RH maternal/RH please medicines For For eachresponse theinterviewer should available

indicate whether it whether it indicate and note the note and validate the responsethe validate h Item

available by a physical Inventory physical a by finding appropriate provided for provided 012:

health facility, facility, health

March 2012 99 | Page

Inventory Inventory No No Tick only one one only Tick Tick only one one only Tick opon) ( 1Yes 1Yes 2 2 opon) (

…………………….. taken, taken, stockNOT in Females Females contracepve is contracepve is

stockin

Sterilisaon for

Inventory Inventory No No Tick only one one only Tick Tick only one one only Tick ( opon) …………………….. 1Yes 1Yes 2 opon) 2 (

taken, taken, stockNOT in contracepve is contracepve is

Male stockin

Inventory taken, Inventory taken, No No Tick only one one only Tick Tick only one one only Tick ( opon) 1Yes 1Yes opon) 2 2 ( …………………….. contracepve in is contracepve NOT is stock stockin

Inventory taken, Inventory taken, No No Tick only one one only Tick Tick only one one only Tick ( opon) 1Yes 1Yes opon) opon) 2 2 ( …………………….. ……………………..

contracepve in is contracepve is Injectables Injectables Condoms Female Sterilisaon for stock stockNOT in

s alpmI t n Inventory Inventory No No Tick only one one only Tick Tick only one one only Tick ( opon) 1Yes opon) opon) 1Yes 2 2 ( ……………………..

taken, taken, stockNOT in contracepve in is contracepve is

stock

ION ITEMfor 013 T

s Inventory taken, No Inventory taken, Tick only one one only Tick D No ( opon) 1Yes 2 Tick only one one only Tick …………………….. …………………….. opon) 1Yes 2 ( UI UI

contracepve in is contracepve is stock stock NOT in

INTERVIEWERVERIFICA

sll iP l Inventorytaken, Inventory taken, ar No No Tick only one one only Tick Tick only one one only Tick ( …………………….. …………………….. 1 Yes 2 opon) opon) opon) 1Yes 2 ( O O

contracepve in is contracepve is stock stock NOT in

NO STOCK OUT OF MODERN CONTRACEPTIVE METHODS SDP AT STOCK MODERNCONTRACEPTIVE OUT NO OF sm o

d n o c e laM Inventory taken, Inventory taken, No No Tick only one one only Tick Tick only one one only Tick …………………….. …………………….. ( opon) 1Yes opon) 1Yes 2 2 ( Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES

contracepve in is contracepve is stock stock NOT in

f

UNFPA UNFPA Global Programme to Enhance Reproductive Health Commodity Security is not

2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health tem 013,the i the number of of numberthe is currently in in is currently

at this health facility, facility, health at this

indicate the main reason main reason the indicate For each of thecontracepve each of For out of stock at this health facility atof this stock out at in your health center in the last six six center thelast your health in in in this health facility health this in If the contracepve method was out o out was thecontracepve If method For each of the contracepve each of Methods For If If me urrently in stock urrently stock in acility, in the last six months, please months, six the last in acility, tI 0 stock the survey preceding months interviewer validatethe a responseby should f c please indicate the main reason indicate main reason the physical Inventory physical and thenote appropriate

013) 15) whether has it indicate please methods finding finding please indicate whether it indicate please stock been months the last six any given day, in yes,indicate please days the contraceptive method was out of wasof out method days the contraceptive the contracepve method For For eachresponse for provided 016) 017) health me given at this any at stock 014) preceding the survey, and therefore preceding the therefore survey, and that to at time clients give unavailable to

March 2012 100 | Page

Inventory Inventory (Tick only one one only (Tick opon) 2 No taken, tracer stock in drug is NOT in drug is stock (Tick only one one only (Tick opon) 2 No Folic Acid Tablets 1 Yes 1 Yes taken, tracer …………………

Inventory Inventory (Tick only only (Tick (Tick only only (Tick opon) one 2 No 2 No drug is in in drug is NOT in drug is stock 1 Yes Suspension one opon) opon) one taken, tracer stock taken, tracer Amoxycillin 1 Yes ………………..

Inventory Inventory one opon) one (Tick only only (Tick (Tick only only (Tick 2 No taken, tracer NOT in drug is one opon) one 2 No drug is in in drug is stock stock 1 Yes 1 Yes taken, tracer Amoxycillin Capsules ………………

Inventory Inventory 2 No (Tick only only (Tick (Tick only only (Tick opon) one taken, tracer NOT in drug is 1 Yes 2 No drug is in in drug is stock 1 Yes one opon) one stock taken, tracer Trimoxazole Co- Syrup ………………

Inventory Inventory one opon) one 2 No taken, tracer NOT in drug is (Tick only only (Tick (Tick only only (Tick 2 No stock one opon) one drug is in in drug is 1 Yes 1 Yes stock taken, tracer Tablets Tablets Co- Trimoxazole ……………… ………………

TRACER DRUGS AT SDP TRACER SDP DRUGS AT

Inventory Inventory (Tick only one one only (Tick opon) taken, tracer NOT in drug is (Tick only one one only (Tick opon) drug is in stock in drug is stock 1 Yes 2 No 2 No 1 Yes

taken, tracer (Paediatrics)

………………… …………………

TION ITEMfor 018

Inventory Inventory opon) opon) 1 Yes (Tick only one one only (Tick 2 No 2 No taken, tracer stock in drug is NOT in drug is stock 1 Yes opon) (Tick only one one only (Tick taken, tracer A.C.T. (Adult) A.C.T. A.C.T.

………………… …………………

(If No, then items 018b to 037 should NOT be administeredbe NOT interview terminates) and 037 should No, 018b items to (If then INTERVIEWER VERIFICA Inventory Inventory one opon) one taken, tracer 2 No drug is NOT drug is (Tick only only (Tick only (Tick opon) one 2 No drug is in in drug is stockin 1 Yes 1 Yes stock taken, tracer Ibuprofen Tablets ………………

NO STOCK OF OUT Inventory Inventory one opon) opon) one taken, tracer in drug is NOT in drug is stock

(Tick only only (Tick 2 No 1 Yes 2 No 1 Yes Syrup (Tick only only (Tick Paracetamol one opon) one stock taken, tracer

……………… ……………… l oma

tecar Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES Inventory Inventory a ………………… ………………… Does this facility receivevaccines facility the Government’sfrom Does drugs and/or this medical Free Care Health Iniave/Programme? one opon) opon) one taken, tracer 2 No 2 No

stock drug is in in drug is (Tick only only (Tick (Tick only only (Tick Tablets stock taken, tracer one opon) opon) one drug is NOT in NOT in drug is

1 Yes P 1 Yes

(Connue with Item with 018b) (Connue 2 No UNFPA UNFPA Global Programme to Enhance Reproductive Health Commodity Security 018a)

, the was 1 Yes 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health out stock of currently in item 018 is in currently

tracer drug is not please indicate the in your health center the health in your in For each of the tracerof drugs, each For at this health facility, please facility, health at this For each of the tracer of each For please drugs, If the tracerIf drug If yes in Item 020, please indicate Item yesIf 020, in indicate please stock the tracerIf of drug was out me tI 020) indicate the main reason 019) main reason the last six month, month, six the last stock at this health facility at any day,in given indicate whether it has been whether has it indicate physical Inventory physical and thenote appropriate validateinterviewer the a response by should 021) out stock of 022) in facility health at any given at this me 018b) whether it indicate please For For each response forprovided

the number of days of thenumber the last six months preceding the survey preceding months six last finding finding the lastsix months preceding the unavailablesurvey, and therefore to to thatgive at clients me in this health facility health stock this in

March 2012 101 | Page

Inventory Inventory Inventory

……………… Fansidar (Sulpha/ Pyrim) 1 Yes 1 Yes stock only (Tick opon) one taken, tracer in drug is stock taken, tracer NOTdrug is in 2 No 2 No only (Tick opon) one

Inventory Inventory Inventory

………………..

Tablets MethylDopa 1 Yes stock 1 Yes 2 No

taken, tracer NOTdrug is in 2 No opon) opon) drug is in stock in drug is taken, tracer (Tick only one one only (Tick (Tick only one one only (Tick

Inventory Inventory Inventory

……………… ………………

Syrup Metronidazole stock 1 Yes

1 Yes

2 No opon) taken, tracer stock in drug is taken, tracer NOTdrug is in

(Tick only one one only (Tick one only (Tick opon) 2 No

Inventory Inventory Inventory ………………

Tablets Metronidazole 1 Yes stock 1 Yes

taken, tracer taken, tracer 2 No opon) NOTdrug is in

(Tick only one one only (Tick one only (Tick opon) drug is in stock in drug is 2 No

Inventory Inventory

………………

Tablets 1 Yes stock stock 1 Yes taken, tracer taken, tracer 2 No only (Tick opon) one only (Tick opon) one drug is NOT in NOTdrug is in

drug is in in drug is

2 No

Inventory Inventory Inventory

………………… Zinc Tablets Albendazole 1 Yes 1 Yes stock stock taken, tracer

2 No only (Tick taken,tracer NOTdrug is in 2 No only (Tick opon) one one opon) opon) one drug is in in drug is

TRACER DRUGS AT SDP

Inventory Inventory Inventory

………………

Rehydraon Salt (O.R.S.) stock stock

1 Yes taken, tracer 2 No only (Tick opon) one

1 Yes taken, tracer NOTdrug is in

(Tick only only (Tick 2 No one opon) opon) one drug is in in drug is

INTERVIEWER VERIFICATION ITEMfor 023

NO STOCK STOCK NO OUT OF Inventory Inventory Inventory ………………

Vitamin A Oral 1 Yes in stockin 2 No opon) one 1 Yes taken, tracer stock taken, tracer (Tick only only (Tick opon) one drug is in in drug is NOT is drug 2 No (Tick only only (Tick

Inventory Inventory Inventory

………………

taken, tracer 1 Yes Tablets

only (Tick opon) one

1 Yes taken, tracer stock

2 No (Tick only only (Tick Fefol drug is NOT is drug stockin 2 No one opon) opon) one drug is in in drug is

e

t Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES alosreF Inventory Inventory 1 Yes

………………

… 1 Yes

2 No in stockin opon) one stock taken, tracer (Tick only only (Tick

drug is NOT is drug taken, tracer in drug is 2 No (Tick only only (Tick opon) one Tablets UNFPA UNFPA Global Programme to Enhance Reproductive Health Commodity Security

, the was 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health out of stock of out currently in item 023

racer drug is not

is currently in stock please indicate the in your health center the health in your in at this health facility, please facility, health at this For each of the tracer of please each For drugs, For each of the tracer drugs, please please tracer the drugs, of each For If yes in Item 025, please indicate Item yesIf 025, in please indicate If the tracerIf drug If the tracer drug was out of stock of the tracerIf was out drug

m etI 025) at this health facility at any day,in given

the number of days of number the the t interviewer should validateinterviewer the a response by should in this health facility health this in 023) whether it indicate the lastsix months preceding the that at togive me clients finding finding 026) the survey preceding months six last 024) at any given me at this health facility in in facility health at this me given at any survey, and therefore unavailablesurvey, to and therefore out stock of the last six month, month, six the last 027)

indicate main the reason For For each response for provided physical Inventoryphysical and note the appropriate stock main reason indicate whether it has been whether has it indicate

March 2012 102 | Page

Inventory Inventory Inventory No No Tick only Tick only Tick only ……………… drug NOT is in 1 Yes taken, tracer taken, tracer stock Anbioc IV: 1 Yes ( 2 opon) one drug is in drug in is 2 opon) one Ampicillin (

stock

Inventory Inventory Inventory No No Tick only Tick only Tick only only Tick taken, tracer ………………… drug in is drug NOT is in IV: IV: 1 Yes stock 1 Yes ( 2 stock Gentamycin opon) one 2 Anbioc opon) one taken, tracer (

Inventory Inventory No No Tick only Tick only Tick only only Tick ……………… drug in is drug NOT is in stock IV: IV: 1 Yes 2 ( Penicillins stock 2 opon) one taken, tracer taken, tracer Anbioc opon) one 1 Yes (

Inventory Inventory Inventory No No Tick only Tick only Tick only only Tick ……………… ………………

drug is in drug in is drug NOT is in stock Gluconate ( 2 stock IV opon) one 1 Yes 2 taken, tracer taken, tracer Calcium opon) one 1 Yes (

RACER DRUGS AT SDP T

Inventory Inventory Inventory No No drug is in drug in is drug NOT is in stock stock taken, tracer taken, tracer Tick only Tick only Tick only Tick only ……………… ………………

( one opon) one

( Magnesium Sulfate IV 1 Yes one opon) opon) one 2 2 1 Yes

ni ty

c o Inventory Inventory Inventory x No No NO STOCK STOCK NO OUT OF Tick only Tick only Tick only Tick only

……………… drug is in drug in is drug NOT is in stock 1 Yes one ( opon) ( opon) stock

IM/IV taken, tracer taken, tracer 1 Yes one 2

2 O

, the was out of stock of out tem 028 currently in i

racer drug Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES is not

please indicate the UNFPA UNFPA Global Programme to Enhance Reproductive Health Commodity Security in your health center the health in your in 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health at this health facility, please facility, health at this For each of the tracer of please For each drugs, If If If F metI 30) tock 0 at any given me health facility in at this out stock of the survey months preceding six last the last six months preceding the six the months preceding last the month, six the last main reason For each response forprovided Inventoryphysical and thenote appropriate 029) thetracer drug 031) days of thenumber the t yesItem in 030, pleaseindicate s survey, and therefore unavailable tosurvey, therefore and that time at give to clients indicate whether it has been whether has it indicate 028) please thetracer drugs, of or each indicate main the reason at this health facility at any day,in given finding in this health facility this in indicate whether is it currentlyindicate in stock 032) stock thetracer of drugwasout interviewer validate the should response a by

March 2012 103 | Page

) TT( TT( d io x oT oT

suna i

Inventory taken, Inventory taken, t No No e Tick only one one Tick only Tick only one one Tick only 1 Yes ( vaccine stock NOT is in opon)

………………… ( opon) opon) vaccine s instock 1 Yes 2 2

T T

r eveF eveF

w o Inventory Inventory ll Inventory eY se eY No No Tick only one one Tick only Tick only one one Tick only 1 Yes ( 1 Yes taken,vaccine 2 opon) is in stockis in is NOT stock in ………………… ( 2 taken,vaccine opon) opon)

l s a Inventory Inventory Inventory eM No No Tick only one one Tick only Tick only one one Tick only ( taken, vaccine 2 opon) is NOT stock in 1 Yes ……………… ( taken,vaccine 1 Yes 2 opon) opon) is in stockis in

V Inventory Inventory Inventory CP a CP No No Tick only Tick only Tick only Tick only 1 Yes ( taken, vaccine 1 Yes 2 one opon) one ( is NOT in

……………… 2 taken,vaccine

one opon) one stock is in stockis in

ION ITEMfor 033 T t Inventory Inventory Inventory n e No No Tick only Tick only Tick only Tick only P 1 Yes 1 Yes ( taken, vaccine

2 opon) one ……………… is NOT in (

2 taken,vaccine

one opon) opon) one stock is in stockis in

VPO Inventory Inventory Inventory NO STOCK NO STOCK OUT AT SDP VACCINES OF INTERVIEWER VERIFICA No No Tick only one one Tick only Tick only one one Tick only 1 Yes ( taken, vaccine is

2 1 Yes opon) ………………… ( NOT stock in

opon) opon) 2 taken, vaccine is in stock

G Inventory Inventory C No No Tick only one one Tick only Tick only one one Tick only B ( taken, vaccine is

2 ………………… ( NOT stock in 1 Yes opon) opon) opon) taken, vaccine is 2 1 Yes in stock

, the was Medicines in Service Delivery Points in Sierra Leone: VOLUME TWO –TABLES out of stock of out tem 033 currently in i

UNFPA UNFPA Global Programme to Enhance Reproductive Health Commodity Security tracer drug is not

is currently in stock 2011 Survey of Availability of Modern Contracepves and Essenal Maternal and Reproducve Health please indicate the the tracer drug was out of stock the tracer of drug was out at this health facility, please facility, health at this F F If If If

me tock t finding finding 037) in facility health at this at any given me give to clients at that at me give to clients in this health facility this in been whether has it indicate center the in health out your stock in of the survey months preceding six last indicate whether it indicate the last six month, month, six the last main reason 036) days of thenumber the yesItem 035, in pleaseindicate 034) thetracer drug I interviewer validate should the response a by s at this health facility at any day,in given indicate main the reason For For each response forprovided Inventoryphysical and note the appropriate the lastsix months preceding the unavailablesurvey, and to therefore 035) please thetracer drugs, of or each 033) please tracer the drugs, of or each

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