MSF and MSF Podcasts : London-Freetown - More than five years after the end of one of Africa's most devastating civil wars, Sierra Leone's health status is still disastrous and yet more lives could be saved by some relatively simple changes.

Médecins Sans Frontières (MSF), a medical emergency organization which has been working in the country since 1994, shows in a new report that people are still dying from very preventable causes. People are suffering because the health system cannot cope. Through patients' personal stories, the report focuses on three particular areas where MSF says change can be made: malaria treatment, the provision of mother and child health care and the charges levied on patients.

Across the country, malaria is widespread and lethal. Continuing delays in using the effective medication against malaria - Artemisine-based Combination Therapy (ACT) - are causing the unnecessary death of many people, especially children. An MSF survey done in 2005 shows that up to 63 per cent of deaths in children under five were caused by the disease. Although the Ministry of Health agreed two years ago to implement ACT treatment, the drugs are still not available to the majority of patients.

In the area of maternal and child health, MSF says that providing "waiting houses" attached to district hospitals, can help women with complications at delivery to receive timely medical assistance. Pregnant women can spend the last few weeks before delivering in such structures and, because they are close to the hospitals, they have immediate access to assistance. Those houses are also cheap and easy to run.

Finally, is MSF showing that charging patients substantially reduces the number of sick people who come to health facilities, even when they are seriously ill. In the survey that MSF carried out last year, we found out that only one out of three household declared using the nearest health center during their last episode of illness. In theory, sick people who are unable to pay should be protected by an exemption system, yet the system is not working and the poorest are the first victims.

"We don't pretend to solve the structural problems of under-development in Sierra Leone," said Jonathan Heffer, MSF's Head of Mission in Sierra Leone. "But these changes would make a dramatic difference to reducing suffering and death. And they can be done, as we have shown in our projects".

For more information, you can download the report Lessons from pain and the summary of the 2005 survey Access to healthcare in post-war Sierra Leone.