Health in Sierra Leone

The Ministry of Health and Sanitation (MoHS) sets national policy and regulates health services. The National Public Health Agency (NPHA) handles public-health surveillance and emergencies. District Health Management Teams (DHMTs) coordinate services and referrals with local councils, health management committees and providers. Sierra Leone's system has three main levels: Peripheral Health Units (PHUs), district hospitals and referral hospitals. PHUs include Community Health Posts and Community Health Centres. Community Health Workers (CHWs) extend basic services through home visits and outreach, especially where distance and transport limit facility access. Before illness becomes severe, services commonly include health education, hygiene and sanitation advice, vaccination, nutrition support, malaria prevention and bed nets, antenatal care, facility-delivery support, and reproductive, maternal, newborn, child and adolescent health services. Integrated community case management (iCCM) allows trained community workers to assess and treat pneumonia, malaria and diarrhoea in children aged 2 to 59 months. Children older than five can receive malaria testing and treatment through relevant services. UNICEF reported more than 8,000 CHWs, about 300,000 home visits and cold-chain coverage in 94% of facilities in 2024. Penta-3 vaccination coverage exceeded 80% in each district, and four new vaccines were introduced during that reporting period. A PHU is normally the first place for general assessment, diagnosis and treatment. Staff refer severe or complicated cases to a district hospital, which may provide inpatient care, laboratory tests, imaging, oxygen, intravenous fluids, antibiotics, surgery, intensive care or blood transfusion depending on its capacity. Referral hospitals provide more specialised secondary and tertiary services, but staffing, equipment, medicine supplies, roads and geography make service quality and availability uneven. The 2025 Hospital Strategy covers more than 50 secondary and tertiary hospitals. Access to non-communicable disease care remains limited, and mental-health services have a particularly large unmet need; the MoHS estimated a mental-health treatment gap of about 98% in 2025 while treatment, rehabilitation and community integration were still being expanded. For a serious emergency, the NPHA's 117 centre is publicly described as operating 24 hours a day. The National Emergency Medical Service (NEMS) supports ambulance referrals from PHUs to hospitals. An August 2023 NEMS report recorded 101 ambulances, 88% operational, 91,828 cumulative calls, 85,340 missions and 71,022 referrals. That report also listed the toll-free number 300400, while more recent public communication uses 117; verify the locally current number when possible. Ambulance availability and response times vary, and MoHS reporting in September 2026 identified last-mile and rainy-season gaps. The Free Health Care Initiative (FHCI) provides no-cost priority access in public facilities for pregnant women, lactating mothers and children under five. Treatment for malaria, tuberculosis, HIV/AIDS, leprosy, onchocerciasis, lymphatic filariasis and other designated neglected tropical diseases is free for all people in Sierra Leone. This does not mean that every service is free for every age group. People outside the FHCI groups may pay public registration, consultation and medicine charges under cost-recovery arrangements. Private care generally involves user fees, especially in urban areas. Medicines outside the covered programs can create additional out-of-pocket costs. The World Health Organization reported that out-of-pocket spending represented about 56% of total health expenditure in 2025, while social health-protection coverage remained below 1%. Proposed integration of FHCI and the Sierra Leone Social Health Insurance (SLeSHI) system through a draft bill was not settled law in the available research. The National Medicines Policy and Essential Medicines List (EML) guide medicine selection and supply, but availability can vary by facility. People in rural, remote and riverine communities face greater barriers from distance, roads and transport. National health policy aims to provide timely, quality care without undue financial hardship, yet the available sources do not establish a nationwide patient ombudsman or a single reliable complaints mechanism. Community, facility and local-council committees provide participation and oversight in some settings. Practical responsibilities include following treatment and referral advice, observing infection-prevention instructions and reporting emergencies or suspected disease signals. Follow-up should continue until symptoms resolve or the responsible provider changes the treatment plan. Facilities may monitor treatment adherence and refer severe or unresponsive cases to a higher level. Rehabilitation centres, speech and physical rehabilitation, psychological support, and palliative or supportive care form part of the intended continuum, but access and return-referral arrangements remain fragmented. The actual care pathway therefore depends on the condition, the facility's capacity, transport, medicine availability and whether public, private, faith-based or NGO-supported care is being used.