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Analytical summary - Service delivery

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Health service delivery remains a challenge in post-war Sierra Leone. The 10-year war, which ended in 2002, seriously damaged the health system. This situation continues to undermine standards, availability and accessibility of services provided. The country’s health service delivery system is pluralistic: Government, religious missions, local and international nongovernmental organizations and the private sector all provide services. There are public, private for-profit, private non-profit and traditional medicine practices.

The private sector is underdeveloped compared with other countries in the subregion such as Ghana and involves mainly curative care for inpatients and outpatients on a fee-for-service basis. Private health facilities operate under the authority of individual owners and/or boards of directors, mainly in urban areas. The non-poor tend to use private health facilities more often than the poor.

Traditional healers and traditional birth attendants are reported to provide a significant amount of health care, with traditional birth attendants attending to almost 90% of deliveries at community level.[1][2][3][4]

Health service organization is based on the primary health care concept, which began in the 1980s. Peripheral health units are the first-line health services and are further subclassified into three levels:[1][2][5]

  • maternal and child health posts at village level, covering populations of less than 5000
  • community health posts at small town level, covering populations between 5000 and 10 000
  • community health centres at chiefdom level, usually covering populations ranging from 10 000 to 20 000.

Secondary health care services are available at district hospitals, which provide back-up for the peripheral health units. The district health management team is responsible for the overall planning, implementation, coordination, and monitoring and evaluation of the district health services under the leadership of the District Medical Officer.

Tertiary health care services are provided at regional and national hospitals, where various cadres of specialists are available.

At present, only a few hospices provide services for clients requiring long-term and chronic health care services. Physiotherapy services are available in some hospitals, while rehabilitation services are also provided for leprosy and tuberculosis patients, notably at the Masanga and Makeni hospitals in the Northern Region, and at the Lakka Hospital in the Western Area.

Dental health services are available in Sierra Leone. In total, there are six dentists, two of whom work in government service.

Mental health services are available, mainly in Freetown. The Ministry of Health and Sanitation, in collaboration with partners, has recently developed a Mental Health Policy.

Qualitative perceptions from rural communities reveal that physical distance to health facilities presents a major access barrier to care. The existing functional health facilities are inadequate and inequitably distributed nationally. They are also poorly equipped to provide quality health care services.

Service utilization and uptake of available low-cost, high-impact interventions are low. The general population utilization rate of health services in Sierra Leone is estimated at 0.5 contacts per capita per annum. This means that half the population attend a health facility once every year.[1]

There is a critical shortage of skilled health staff, the impact of which is worsened by the total absence of skilled staff in most peripheral health units, thus compromising the quality of care provided. Basic necessities and amenities in the form of transportation and accommodation remain inadequate.

There are regulatory bodies with statutory authority that oversee the provision of health care in the country, including the Medical and Dental Council of Sierra Leone, the Sierra Leone Nurses and Midwifery Board, and the Sierra Leone Pharmacy Board.[1]


  1. 1.0 1.1 1.2 1.3 National Health Sector Strategic Plan 2010–2015 (pdf 1.09Mb). Government of Sierra Leone, Ministry of Health and Sanitation, 2009
  2. 2.0 2.1 Performance report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010
  3. WHO Country Cooperation Strategy 2008–2013 Sierra Leone (pdf 943.71kb). Brazzaville, WHO Regional Office for Africa, 2009
  4. WHO Country Cooperation Strategy at a glance: Sierra Leone 2008 (pdf 261.91kb). Brazzaville, WHO Regional Office for Africa, 2009
  5. Gibril A et al. Sierra Leone health sector review, 2004