More than a year after the launch of the Free Health Care Initiative, pregnant women and girls in Sierra Leone continue to face serious challenges in accessing the drugs and medical care crucial for safe pregnancy and childbirth, Amnesty International said today. Under the Initiative, all pregnant women and lactating mothers should receive free treatment at government-run health facilities. However, a new Amnesty International report, At a Crossroads: Sierra Leone’s Free Health Care Policy, reveals that many of these women are being asked to pay for drugs, which they cannot afford. “The health care system remains dysfunctional in many respects.” said Erwin van der Borght, Amnesty International’s Africa programme director. “Government figures show that since the introduction of the Initiative, more women are accessing antenatal care and delivering their babies in health facilities. However, many women continue to pay for essential drugs, despite the free health care policy, and women and girls living in poverty continue to have limited access to essential care in pregnancy and childbirth.” The government of Sierra Leone has introduced some initiatives to address these challenges. These include steps to increase women's access to health services, increasing the pay of health workers and providing those workers with additional training. However, much remains to be done. “A critical shortcoming within the healthcare system is the absence of any effective monitoring and accountability systems, without which reforms cannot succeed,” said Erwin van der Borght. The existing processes are poorly resourced and focus on reviewing individual facilities rather than on monitoring the obstacles women face in accessing services. There are no effective complaint mechanisms available to women and girls when their human rights are denied. A 23-year old woman who had just given birth told Amnesty International: “My baby was crying a lot and had a fever. Hospital had no drugs for him. Need to pay money. They chased me away. I don’t know how to complain.” Monitoring and accountability are vital to the realization of the right to health. An effective framework of monitoring and accountability serves as the basis for promoting changes which allow women and girls to enjoy their right to maternal health and give birth more safely. “The government has taken some important steps to address these challenges. However, deficiencies in the monitoring and accountability system allow poor practice and mismanagement to go unchallenged, and have provided some people with opportunities to exploit the system and plunder valuable medicines,” said Erwin van der Borght. Amnesty International welcomes the positive response received from the Ministry of Health and Sanitation on sharing this report with them, but the planned reforms must be translated into action. Amnesty International is calling on the Sierra Leone government to strengthen and establish systems of monitoring and accountability to ensure health care interventions are accessible to women and girls and to guarantee their access to effective remedies for violations of their human rights.