In the diamond-rich Kono District, 90% of all buildings were burned or looted during Sierra Leone's civil war. The physical and human resources of the primary health care (PHC) system in Kono were deeply affected. After tentative peace was declared in 1999, many of the refugees that had fled the war returned, necessitating the reconstruction of infrastructure, including the devastated PHC units. World Vision Sierra Leone (WV) assisted in the rehabilitation and post-conflict support of 35 clinics in Kono with monies from USAID's Office of Foreign Disaster Assistance (OFDA). In June 2005, a modified version of the MEASURE BASICS Integrated Health Facilities Assessment tool was used to test the progress of WV, the Government of Sierra Leone's Ministry of Health, and other health rehabilitation partners in bringing the clinics of Kono District to current WHO Integrated Management of Childhood Illnesses (IMCI) standards. The specific objectives of WV's OFDA project, “FY04 Development Relief Initiative Kono District, Sierra Leone,” are measured by this survey and the results obtained show the following: (1) The drug, vaccine, and equipment supplies at the clinics in Kono District are stable. While specific, remediable deficits exist, the progress made during the rehabilitation and support of these clinics has been significant. Concrete, minimal interventions such as further provision of solar refrigeration, the combination of drug supply and supervision visits, and the testing of a referral program could help to improve the physical and material conditions for Kono District implementation of IMCI. (2) Health worker skill in vaccine administration, childhood sickness diagnosis and treatment, and record keeping is generally poor. These human-resource challenges constitute the largest impediment to successful IMCI strategies in Kono. Failures in care delivery should be addressed through concerted, long-term efforts to train health workers in the IMCI model.
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