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Analytical summary - Social determinants

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Population movement across Sierra Leone´s borders is high. The vegetation ranges from mangrove along the coast to forest-covered hills and savannah further inland, which can harbour vectors of diseases.


About two thirds of the population live in rural areas while a third live in urban areas, mainly in the capital city of Freetown.

The population of Sierra Leone, estimated at 5.5 million in 2008, has a natural increase rate of 2.3% per annum, with children 0–14 years representing about 45% of the population. The crude birth and death rates are 45 and 22 per 1000 population, respectively. The total fertility rate is among the highest in the world.

Life expectancy at birth is estimated at 49.4 years and is associated with the high child and maternal mortality rates, as well as the heavy burden of communicable and noncommunicable diseases in the country. Underlying factors are:

  • pervasive poverty
  • high level of illiteracy, especially among females
  • limited access to safe drinking water and adequate sanitation
  • poor feeding and hygienic practices
  • overcrowded housing
  • limited access to high-quality health care services.

Sierra Leone ranks as the least developed country in the world, based on the Human development report, 2007 ranking it 177 out of 177 countries.[1] The country is extremely resource poor, with a gross domestic product per capita of US$ 700, based on purchasing power parity. It ranked 102 out of 108 countries in the Human Poverty Report, with a Human Poverty Index of 51.72. Nearly half of the working age population engages in subsistence agriculture.[1]

The fate of the economy depends on the maintenance of domestic peace and the continued receipt of substantial external aid, which is essential to offset the severe trade imbalances and supplement Government revenues. However, progress is being made, especially in creating an enabling environment for socioeconomic development.

In response to these socioeconomic challenges, the Government of Sierra Leone has developed the Sierra Leone Vision 2025 and the Sierra Leone Poverty Reduction Strategy, which guide its efforts toward improving the current socioeconomic situation.

Intercountry collaboration is carried out through the Mano River Union as well as the Economic Community of West African States. In 2006, the economy witnessed an overall impressive performance with real gross domestic product growth estimated at 7.8%. Growth was driven by a revitalized bauxite and rutile mining sector, coupled with sustained agricultural output and service delivery.

Sierra Leone is politically a constitutional democracy. The Parliament of Sierra Leone is unicameral, having one chamber with 124 seats. The civil war, which lasted from 1991 to 2002, destroyed basic health infrastructure and displaced health personnel, compromising health care at all levels in the country.

With the support of the United Nations and developmental partners, Sierra Leone commenced the rebuilding of governance infrastructure, beginning with the disarmament and demobilization of ex-combatants in February 2002. This was followed by successful presidential and parliamentary elections on 14 May 2002. About 5 years later, on 28 July 2007, another parliamentary and presidential election took place that witnessed the transition of power from the then ruling party to the previous opposition party.

This transition was a major milestone in the re-establishment of a robust constitutional democracy in the country and marked the end of the recovery phase and the beginning of the peace-building and development phase of post-conflict Sierra Leone. The present Government of Sierra Leone is consolidating the gains made by the previous one and is pursuing the President´s Agenda for Change as the main vehicle guiding development efforts in the country.


  1. 1.0 1.1 Sierra Leone health and demographic survey 2008: key findings (pdf 3.15Mb). Calverton, Maryland, Statistics Sierra Leone and ICF Macro, 2009