This report presents the third ex-post cost-efficiency analysis results of the Saving Lives in Sierra Leone (SLiSL) programme for the period of January–December 2021. The SLiSL programme is supporting the Government of Sierra Leone to save women’s and children’s lives by improving the quality, availability and accessibility of reproductive, maternal, new-born, child and adolescent health (RMNCAH) services. While the outputs and efficiency were largely maintained during this implementation period, quality and impact were adversely affected by significant funding cuts, therefore effectiveness is not expected to be maintained compared to the previous implementation period.
Efficiency had increased in 2021 (£4,489/mentee) compared to 2020 (£6,186/mentee), largely due to funding cuts that necessitated adaptations in mentorship sessions and exacerbated staff shortage. Moving forward, some mentorship activities may be covered by DHMT operational support funds, which would increase district ownership and sustainability of the programme.
Family Planning Services Provided Through Outreach
Efficiency in 2021 (£3.40/CYP) was higher compared to 2020 (£4.93/CYP), largely due to funding cuts and remapping sites to target more productive areas. Clinical audiovisual assessments (CAVA) conducted remotely kept costs low while maintaining clinical quality.
Family Planning Services Provided Through Public Sector Strengthening (PSS)
Efficiency in 2021 (£10.12/CYP) was maintained compared to 2020 (£10.56/CYP). Funding cuts compromised mentorship dosage and decreased overall mentee competency, but the supported health facilities are expected to improve and be phased out in 2023.
Efficiency in 2021 (£0.01/unit of drug distributed) was equivalent to 2020 (£0.01/unit of drug distributed). NMSA is likely to move forward with the strategy to insource last mile distribution by utilising already donated delivery vehicles and MoHS personnel at the district level to improve efficiency.