Sierra Leone’s Health Care System Overwhelmed as
Demand for Free Health Care Exceeds Supply
Abdul R Thomas
Editor - The Sierra Leone Telegraph
3 May 2010
It is now six days since the President launched a
free health care provision for lactating mothers,
pregnant women and children under five years old.
Already, there are signs of the nation’s crippling
Health Service becoming overwhelmed, as demand far
exceeds the supply of drugs, beds, nurses, doctors,
and equipment. Is the nation’s Health Care Service
In his speech marking the launch of this new
programme, President Koroma proudly announced that;
“From this Independence Day, every pregnant woman,
breastfeeding mother and child under five years of
age will be entitled to free health care in every
Government health facility in the country. From
pre-natal check-ups to surgical services, drugs,
vaccinations and inpatient hospital care, no
pregnant woman, breast feeding mother or child under
five would have to pay a single Leone.”
Sierra Leone’s Health Care Service is facing the
greatest challenge since its formation over fifty
years ago. At the best of times, for the country’s
population of over five million, it is a life and
death struggle trying to access the available
limited medical care, which is being rationed on a
fee paying basis.
With an average daily income of less than 50 US
Cents, many lives are being lost simply because of
affordability. Poverty, poor medical
infrastructures, and the appallingly skewed ratio of
medical staff to patients, life expectancy is one of
the lowest in the world.
Local cemeteries across the country bear witness to
the high mortality rate of the country’s under
forty-fives; the most economically active in the
population. Local radios’ obituary announcement
makes for very depressing listening, as the average
age of most of the decease is no higher than 40
Hence, few in Sierra Leone would relish the thought
of the country’s health care provision becoming
politicised, nor would they want to see politicians
play politics with their health and consequently
The Global Human Development Index puts Sierra Leone
at the bottom of the scale – with one of the highest
maternal and infant death rates in the world. One in
eight women in the country die during pregnancy or
childbirth; while one in twelve children do not live
to see their first birthday.
President Koroma’s dream of a Sierra Leone that is
devoid of such a poor image, had inevitably and
quite rightly won the admiration of the people.
But it now seems that the good intentions of the
government and their international partners, which
includes; the Department for International
Development (DFID), the United Nations Population
Fund, UNICEF, the World Health Organisation and the
World Bank, had not been matched with sound
management planning. There are suspicions of a mad and
unnecessary rush to meet an irrational deadline.
Some critics say that as with Bumbuna, the overriding
goal for the speedy and hurriedly launch of the new
free health care programme was political expediency,
rather than systematically planning to address the
genuine and desperate health needs of a dying
What are the facts?
It is now understood that the government and their
international partners had planned for the new
health care provision to meet the demands of one
million children and two hundred and thirty pregnant
women. Was this target evidence-based?
Sierra Leone can only boast of five obstetricians and
gynaecologists, seventy-five trained medical
doctors, and eight hundred and twenty-five state
At the best of times the country’s medical staff
struggle to cope with the ever rising demands of a
sickly population. The launch of a free health care
programme will inevitably put tremendous neck
breaking strain on the Heath Service. There is one
doctor for every 67,000 people.
Sierra Leone has an overwhelmingly large female
population. In one of the chiefdoms alone - located
in the south of the country – in the Moyamba
District, with a population of over 3,000 people,
over half the population is female – aged under 60
years old. This community has only one nurse serving
the entire chiefdom.
Critics have warned that the continuous absence of a
substantive Minister of Health will seriously affect
the management and co-ordination of this huge
national programme. The president appears to have
personally taken direct control and supervision of
the delivery of the Programme.
A budget of $80 Million has been set aside by the
international community to meet the cost of
delivering the free health care programme for a
year. But the government has recently decided to
increase the health sector salaries budget to $125
Million per annum, based on the promise by British
Prime Minister Brown to provide additional funding.
"As you may have heard my Government has doubled the
salaries of most health workers and increased
salaries even more for our most skilled workers. By
making this commitment, we the Government will pay
the health workers so that the children and pregnant
women of this nation don’t have this responsibility"
– said President Koroma.
The government is pinning its hope of success on the
skills and care of the country’s hard working health
workers. President Koroma said: “We realise that the
success of this policy depends on the skills and
care of our hard working health professionals. For
many years, previous Governments have not
appreciated the vital contribution our health
workers have made to the health of the nation. Our
doctors and nurses have been underpaid and
But there are reports that doctors and nurses are yet
to receive the promised salary increase, which was
granted them in settlement of the two weeks dispute
that saw widespread walkouts. Is the government now
reneging on its promise?
More hospital beds are needed. $10 Million spent on
medicines in response to the anticipated demand is
far from adequate. New clinics need to be built that
will provide specialist maternal and paediatric
care. Modern medical equipments are needed, with the
trained personnel to use them.
This rise in the health sector wage bill, which was
not previously budgeted for in the original plan for
the delivery of the new programme, has sparked fears
that the country will run out of money to continue
its free access to health care programme. It also
questions the rationale in whipping up growing
expectations by offering free health care, at this
point in the global economic cycle and Sierra
Leone’s exclusive dependence on international Aid.
The current gap in funding for the country’s health
sector is estimated at $20 Million. But critics say
that this deficit will more than quadrupled by the
end of the year, once the awareness raising
programme for the free health care provision reaches
every town and village in the country.
There are media reports of villagers from far afield
as up north, travelling to the capital Freetown in
search of their free medical entitlement.
Expectations must now be managed, if the growing
chaos caused by long queues forming outside
hospitals and health centres across the country is
to be controlled.
The commitment of health workers to ensuring the
success of the programme cannot be denied. During
the country wide sensitization visits by the
Ministry of Health’s Chief Nursing Officer, she told
“I was delighted to leave each meeting knowing that
each and every nurse is as committed as the
government and its partners to delivering free
health care into the future. And in return we are
committed to ensuring our staff receive the right
training and professional development and improved
working conditions to help them deliver the health
care Sierra Leoneans deserve.”
She also mentioned that; “about 1,500 nurses and
health workers from across the country have showed
their support for the programme.” President Koroma
has received plenty of goodwill from the health
workers and must take great care not to lose it. He
must honour the salary increase that he promised the
The international community and President Koroma have
committed themselves to the delivery of a free
access to health care programme that could benefit
over 50% of the country’s population.It is now clear
that for political expediency, they had thrown all
caution to the wind, by setting aside the rigorous
planning process that usually precede the
development and delivery of such a huge national
programme. The nation’s health service is now
A new health crisis is beginning to emerge.
Expectations have been raised far in excess of what
the health infrastructure can deliver. There is no
turning back now. It remains to be seen whether the
programme can be sustained without the international
community increasing their funding contributions.
But to echo the words of President Koroma: "Today, I
want to reassure the Nation that I am determined to
make this policy work." Will the international
community continue to stand shoulder to shoulder
with the President in the face of a looming crisis?
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