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Analytical summary - Universal coverage

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Universal coverage aims to achieve population coverage through universal pooled funding. This is an important objective of most health systems and requires provision of comprehensive preventive and curative care, free at point of delivery to the entire population. This definition implies two dimensions of coverage: breadth and depth.

Breadth refers to the proportion of the population receiving access to the package. Depth refers to the extent of the services that are covered. In almost all societies, even those that are considered wealthy, there is some trade-off between breadth and depth.

At this stage of development, universal coverage for a comprehensive package of services for the majority of the population of Sierra Leone is not achievable. However, other initiatives exist towards universal coverage.

The Free Health Care Initiative[1]
The major barrier for access to health care is related to user fees at the point of service delivery, especially as 69% of health care in Sierra Leone is financed principally from private, out-of-pocket payments.[2] However, with the introduction of the Free Health Care Initiative, this barrier has been removed from pregnant women, lactating mothers and children aged under 5 years.

The Free Health Care Initiative was introduced by His Excellency, The President of the Republic of Sierra Leone, in April 2010. The purpose of this Initiative is to enhance access by ensuring that approximately 230 000 pregnant women and approximately 1 million children aged under 5 years benefit from free health care services.

The Government of Sierra Leone abolished all charges to pregnant women, lactating mothers and children aged under 5 years from 27 April 2010, which was Independence Day. The abolishment of user fees for this target group has led to an increased demand for, and utilization of, services.

Basic Package of Essential Care Services[3]
One of the Ministry of Health and Sanitation’s key responses to improve health service delivery was to develop a Basic Package of Essential Health Services (BPEHS) to guide efficient policy prioritization and implementation. The major focus of the BPEHS is to reduce mortality rates, especially for infants and pregnant women. It seeks to scale-up interventions of the minimum package of essential services. All services in the package must be available as an integrated whole, rather than being available in stages or as an individual service.

The Ministry strives to ensure that the core services making up BPEHS are available nationwide and that additional services that are not part of the BPEHS are added, as and when appropriate. These additional services are not intended to substitute for any of the BPEHS.


  1. Free health care services for pregnant and lactating women and young children in Sierra Leone. Government of Sierra Leone, Ministry of Health and Sanitation, 2009
  2. Leigh B. Child survival and development mid-term review report for the programme 2008–2010. Sierra Leone, United Nations Children’s Fund, 2009
  3. Basic Package of Essential Health Services for Sierra Leone (pdf 2.01Mb). Government of Sierra Leone, Ministry of Health and Sanitation, 2010