The lack of resourced, quality, integrated and people-centred health services, as well as large inequalities in access to sexual and reproductive health services are critical gaps in the national response to cervical cancer.
With an estimated population of 7.9 million people, Sierra Leone has only two psychiatrists, two clinical psychologists, and 19 mental health nurses. There are only four nurses who have specialised in child and adolescent mental health. Sierra Leone has an estimated treatment gap of 98% for severe mental illness conditions (Alemu et al, 2012).
Stigma towards mental illness is a major issue and mental health literacy is extremely low. Rainbow Centres (Freetown, Bo, Makeni, Kenema and Kono) provide support to victims and survivors of rape or sexual assault. Rainbow Centre provides clinical and psychosocial support to victims/survivors of GBV. The NSP 2016-2021 does not mention the issue of mental health or any strategies and interventions for integrating mental health support into HIV and SRHR strategies, programmes and services.
Other gaps are related to the lack of
- Integrated programmes for HIV, SRHR, GBV and mental health, including community-led and –driven programmes and services;
- Youth-friendly and non-stigmatizing mental health programmes; and
- Refresher training and psychosocial support for health care workers providing health and psychosocial support to victims and survivors of GBV.
Women and girls. The NASP 2016-2021 includes gender-transformative interventions and a dedicated budget for implementing these interventions. Sierra Leone has a national prevention strategy to reduce new infections among adolescent girls, young women and their male partners in communities with high HIV incidence. This includes youth-friendly health services, school-based HIV prevention campaigns, social support and economic empowerment.
The First lady of Sierra Leone, Her Excellency Mrs. Fatima Maada Bio, is leading a campaign (Hands Off Our Girls!) to ban early child marriage and sexual violence against women and girls. Gaps in data on gender and intersecting inequalities in the context of HIV pose significant challenges for policy and programme development.
Sex workers, people who inject drugs, men who have sex with men and transgender people participate in policy, guidelines, and strategy development related to their health (AIDS info 2019). The Fufutha Development Association (RODA) is implementing a programme, with the support of the Global Fund, which provides various forms of assistance including health counselling and prevention services for sex workers in Sierra Leone, thereby helping them protect themselves from HIV.
There are significant gaps in crucial data on the following information, especially on sex workers: (a) HIV-related information, including HIV testing and awareness of their status, ART coverage for those living with HIV, coverage of HIV prevention programmes, and sex workers’ avoidance of health care because of stigma and discrimination; and (b) All forms of violence against sex workers, including from uniformed personnel and in health care settings.
There are very limited interventions addressing men, masculinities and gender equality in sexual and reproductive health and rights in Sierra Leone. The Men’s Association for Gender Equality-Sierra Leone (MAGE-SL) is a non-governmental organization and an network of male-led organizations working towards the promotion of gender equality through advocacy, dialogue and raising awareness on gender policies women’s rights and empowerment in Sierra Leone.