Free healthcare for Sierra Leone - and a whole lot of Tony Blairs

Congratulations to Sierra Leone. Yesterday, on Independence Day, the country with one of the worst death rates in the world among women in childbirth launched free healthcare for those who are pregnant or breastfeeding and for the under-5s. It should save thousands of lives.

It hasn't been easy and it says much for president Ernest Bai Koroma's commitment and the dedication and hard work of some of his ministers and officials that it has happened at all. This is a deeply impoverished country still trying to recover from war. It is obvious that if healthcare is free – even to a limited number of people – the clinics and hospitals could be overwhelmed. User fees are a way of rationing when you don't have enough drugs, let alone nurses and doctors, to go round.

But, although there are still those who agree with what at least used to be the thinking of the World Bank (the line seems to have softened) that fees provide much needed investment in healthcare and make the patients value it, these days most people agree that they are a barrier the poorest cannot surmount. So 1,800 women in Sierra Leone die for every 100,000 births and many could have lived if they had been able to pay to give birth in a maternity unit. But at $10 for a normal delivery and $100 for a caesarean, the cost is prohibitive for the 70% of the population who survive on $1 a day.

The government recognised this years ago and made a failed attempt to get rid of user fees in 2002. This time round, it has been substantially supported by aid agencies like Save the Children, the UN and the British government. Although there are divisions within DfID on it, Gordon Brown has been four-square behind the effort to end user fees in Africa - some say because he wanted a legacy when the Taskforce on Innovative Financing for Health Systems pretty much ran out of steam last year – and so has his erstwhile rival Tony Blair.

Blair's Africa Governance Initiative has been working with the Sierra Leone government since October 2008. Blair himself was last there is February, visiting a hospital in Freetown that had abolished fees ahead of the rest. It used to deliver 50 women a year. That, says Faye Melly from the AGI who is working with the health ministry, "went through the roof" once care became free.

Blair is more than popular in Sierra Leone. His father taught in Fourbay College, which used to be one of the leading universities in Africa. It is widely believed that Blair himself went to school in Sierra Leone and he became a hero when he sent in British troops to end the conflict in 2000. Nine and ten year-old boys called Tony Blair are not uncommon now in Sierra Leone.

The AGI has set up sub-committees on infrastructure, communications, finance, drugs and logistics, human resources and monitoring and evaluation and provided strategic advice and support to the chief medical officer and senior health officials. Blair and former health minister Alan Milburn have both visited to cheer Sierra Leone on. DfID has given $8.8 million for new drugs, as well as other help. Weekly meetings have brought together government and donors and aid agencies so that everybody has been in the loop and performed their own specific tasks.

Outside help has been important, but the greatest credit of all, says Melly, goes to ministers and staff who have been working 12 hours a day, seven days a week. "Yes, the donors have been absolutely critical to this effort. But in the end, we have only got to where we are through a genuine partnership in which the government of Sierra Leone have set the course, and partners have lined up behind it," she said.

There have been some major issues. The health minister was sacked last year for corruption. Junior doctors went on strike recently, worried about the impact the reforms would have on their lives. Health workers have been given large pay rises, from three-fold to six-fold, to compensate for the money they will lose when they can no longer charge fees. And there are still considerable worries over the shortages of staff – 50% of the healthcare staff Sierra Leone trains leave for Ghana, the UK or somewhere else where life is not so hard.

But the whole country is excited at the move and the expectation is that the community will help keep things on track. There is a toll-free number for people to call if doctors try to levy charges where there shouldn't be any, or try to charge men extra to make up for lost revenue from women, or if healthcare staff don't turn up for work or the drugs inexplicably run out. There is a real determination to make it work. This is not about political reputations in Sierra Leone or the UK. The lives of thousands of women and small children are at stake.

Now Save the Children, which has been campaigning for the abolition of user fees across Africa, is calling on the next UK government to give other countries the same sort of technical and financial support. "The UK government has pledged support to Ghana, Burundi, Liberia, Malawi and Nepal but they have not benefitted in the same way as Sierra Leone. Extending free healthcare across the continent would make a significant impact on the number of children dying before they reach their fifth birthday. It is estimated that the lives of 233,000 children could be saved if healthcare fees were removed in 20 African countries," it said in a statement.