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The Health System

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Health services are delivered through a network of health facilities. This network consists of 1040 peripheral health units, including community health centres, community health posts, maternal and child health posts and 40 hospitals (23 government owned and the remainder owned by private, nongovernmental and faith-based organizations).[1]

The Government of Sierra Leone, in collaboration with all stakeholders, is putting efforts into the implementation of high-impact interventions. Various policies and reforms, such as the Free Health Care Initiative and the Basic Package of Essential Health Services, have been put in place to improve the health status of women and children.


The sector-wide approach, which is a collaboration between the Government and development partners, is moving towards improving the availability of funding for sector support under Government leadership.

A review of progress on Millennium Development Goals showed that the health-related Millennium Development Goals 4 and 5 may be met by 2015, but only through sustained efforts. Millennium Development Goal 6 is likely to be met in relation to HIV/AIDS and through sustained efforts in the prevention and prompt treatment of malaria and tuberculosis.[2][3]

The introduction of the Free Health Care Initiative increased the health service coverage in 2010. The number of children coming for care at the health facilities increased by 2.5-fold. Antenatal care attendance increased by 3-fold and the proportion of women delivering in institutions reached 54% in 2010.[2] However, maternal and child health status is still poor and the prevalence of major communicable diseases is high. To reverse the downward trend, it is necessary to strengthen community sensitization and improve the quality of services provided at antenatal care centres.[2]

There are still big challenges with inadequate human resources, and the lack of adequate equipment and infrastructure. With regard to human resources, the total workforce in the public health sector increased by 13.4% from 7164 in 2009 to 8125 in 2010. However, only six of the 11 targets of this strategic objective were partially achieved. The major challenge here is the lack of appropriate technical assistance guidance at national and international levels, especially as delays have been experienced in getting support from technical partners, including WHO.[2]

There was progress towards improving health care financing, with an increase of 34% in the total budget for the health sector. In total, 86.5% of the estimated cost of US$ 35 840 173 to implement the Free Health Care Initiative was provided by partners.[2]

Access to affordable medical products and health technologies showed that there has been a huge investment in drug and medical products procurement, including cost recovery drugs, both by donors and by the Government.

There has also been some progress on the health management information system. Reporting completeness increased from 74% in 2009 to 83% in 2010. However, the good progress of the implementation and strengthening of the health management information system has been weakened by the non-existence of functional interoperable human resources for health, financial management and logistics management information systems. Furthermore, the use of information for decision-making has not been widespread within the sector.[2]


  1. National Health Sector Strategic Plan 2010–2015 (pdf 1.09Mb). Freetown, Government of Sierra Leone, Ministry of Health and Sanitation, 2009
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Performance report. Freetown, Government of Sierra Leone, Ministry of Health and Sanitation, 2010
  3. Millennium Development Goals progress report 2010 (pdf 2.82Mb). Freetown, Government of the Republic of Sierra Leone, 2010