THE BLOG

Moving Beyond UK Aid to Improve Health in Sierra Leone

02/07/2015 11:54 BST | Updated 30/06/2016 10:59 BST

The relationship between the UK and Sierra Leone is both historic and complex. It stretches back centuries - encompassing colonialism, and UK intervention in the civil war.

Today the ties between the two countries remain strong - and not always in the ways most visible on the surface.

At face value, the UK is Sierra Leone's largest bilateral donor. In 2013/14 UK aid to Sierra Leone was £70 million - and it has pledged a package worth £427 million to tackle Ebola. Sadly however, aid flows are not the only current link between the countries. These are other stories to tell...

The first is tax.

Tax is fundamental to building strong and sustainable health systems, and reducing reliance on aid. All low and middle income countries which have come close to achieving Universal Health Coverage have done so thanks to heavy reliance on tax revenues.

Yet in the past Sierra Leone has given away huge tax breaks to mining companies. A 2014 study (by Sierra Leone's Budget Advocacy Network and National Advocacy Coalition on Extractives) estimated the country lost $199 (£127) million a year through these tax breaks - predominantly to British companies.

Health Poverty Action's own research, published this week, estimates that based on the companies operating in Sierra Leone in 2014, Sierra Leone could raise an extra $94 (£60) million a year from changes to agreements with extractives companies. That could have funded a lot of health workers.

The extractives industry has seen setbacks due to a drop in iron ore prices recently, meaning this figure should be considered illustrative rather than definitive. But even so, the potential for additional tax revenue to be used to support the struggling health system needs to be explored.

Whilst responsibility for this lies with the Government of Sierra Leone, the UK could offer its support in assessing the contributions the mining industry could make.

It's not just tax breaks that are the issue though. Another - more pernicious - matter is illicit capital flight. This refers to unrecorded flows of illicit finance that are being pilfered from the country, often though tax havens. Sierra Leone is losing more to this each year than it is spending on health.

Here again the link with the UK is especially strong. Thanks to our Overseas Territories and Crown Dependencies, the UK has the world's largest network of tax havens under its jurisdiction, giving us a particular responsibly for this global scandal.

The final story is about health workers.

Our NHS relies on health workers from the world's poorest countries. This saves the UK large amounts in training costs. It means the health systems of low and middle income countries are effectively subsidising the health system of the UK.

The UK has 280 doctors for every 100,000 people. Sierra Leone has two. Yet Sierra Leone is one of a handful of countries to have lost more than half their doctors to countries of the OECD. The subsidy Sierra Leone's failing health system is currently providing to the UK's alone could total as much as £22 million.

The NHS clearly owes a debt to Sierra Leone. Rather than forcing nurses on lower salaries to leave the UK after a set time, as our government last week announced, we should be showing our gratitude for their contribution. Instead of tightening immigration rules, we simply need to fairly compensate the countries that trained the workers providing our heath care.

UK aid is now supporting Sierra Leone's Revenue Authority to strengthen its capacity for tax collection. This has seen impressive results. Aid will be important for some time, no doubt. But giving aid without tackling the root causes of poverty is like trying to fill a bath without putting the plug in.

Rather than simply providing aid, the UK should:

• support Sierra Leone to explore the potential for increased tax revenues to fund healthcare;

• take action to stop illicit capital flight;

• pay compensation for Sierra Leone-trained health workers in the UK.