Sierra Leone

Nurses help a newborn child in Freetown, Sierra Leone. Photo: Dominic Chavez/World Bank

Throughout the five-year project period RRHO supports and complements HRSA’s Resilient and Responsive Health Systems (RRHS) initiative implemented by ICAP at Columbia University in Sierra Leone. In so doing, both projects jointly strengthen the ability of the impact partners to become self-learning organizations that are also interdependent and can promote and capacitate South-South engagement with the goal of contributing to PEPFAR’s human resources for health (HRH) strategy.

Policies & Guidelines

Visit the Resource Library to access and download national policies & guidelines for Sierra Leone.

Country Indicators

Sierra Leone Country Profile (IHME - Global Burden of Disease, 2018)

Population (Global Health Observatory, 2016): 7,396,000
Life expectancy at birth M/F (years) (Global Health Observatory, 2016): 52/54
Under-5 mortality (Demographic and Health Surveys [DHS]): 181/1,000 live births (rural), 158/1,000 live births (urban)
Maternal Mortality Ratio: 1,165 / 100,000
Children <5 underweight (CIA World Factbook): 18.1%
Disease burden (HRH Strategy 2017-2021):

Malaria incidence rate: 406 per 1,000 population at risk
Tuberculosis incidence rate: 310 per 100,000 population
HIV prevalence rate: 1.3% in adults ages 15-49

HIV in Sierra Leone

Since 2010, new HIV infections have increased by 7% and AIDS-related deaths have increased by 6%. Sierra Leone’s fragile health system was weakened by the Ebola virus disease outbreak in 2014–2015. The national response is guided by the National Strategic Plan of 2016–2020. Sierra Leone is the first country in western Africa to have an approved public health approach towards programming for key populations. The country has a funded catch-up plan that is being delivered through the Fast-Track cities initiative (UNAIDS).

Number of people living with HIV (UNAIDS 2017): 61,000 [51,000 - 73,000]
Adults aged 15 to 49 prevalence rate (UNAIDS 201 7): 1.4% [1.1% - 1.7%]
Adults aged 15 and over living with HIV (UNAIDS 2017): 55,000 [46,000 - 66,000]
Women aged 15 and over living with HIV (UNAIDS 2017): 32,000 [27,000 - 39,000]
Children aged 0 to 14 living with HIV (UNAIDS 2017): 5,500 [3,800 - 6,700]
Deaths due to AIDS (UNAIDS 2017): 2,600 [2,100 - 3,200]
Orphans due to AIDS aged 0 to 17 (UNAIDS 2015): 23,000 [18,000 - 28,000]

WHO Building Blocks in Sierra Leone

This WHO framework describes health systems in terms of six core components or “building blocks” including service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership & governance (WHO, 2010). Click on each tab to explore these health system indicators.

Service Delivery

Primary health units (PHUs) (UNICEF 2014): 1,185
Health facility availability of running water (UNICEF 2014, pg.48): 21%
Available water / soap for handwashing at PHUs (UNICEF 2014, pg.50): 98% / 93%
Available detergent / chlorine at PHUs (UNICEF 2014, pg.50): 41% / 9%
Functioning incinerator or appropriate burning pit for waste management at PHUs (UNICEF 2014, pg.52): 72% [53% - 80%]
PHUs with ambulance available on call (UNICEF 2014, pg.52): 59% [45% - 67%]
Facilities with basic equipment required for service delivery (Basic Package of Essential Health Services 2015-2020): 35%
Number of health facilities by district (Basic Package of Essential Health Services 2015-2020): Table 1 below

Table 1: Number of Health Facilities by District, July 2015

Organization unit	MCHP	CHP	CHC	Government Hospital	Private Clinic	Private Hospital	Total
Bo	69	24	28	1	2	3	127
Bombali	55	32	15	1	5	3	111
Bonthe	15	26	14	1	4	2	62
Kailahun	18	42	14	1	1	1	77
Kambia	40	15	13	1	2	1	72
Kenema	60	33	26	1	2	2	124
Koinadugu	43	18	10	1	2	0	74
Kono	44	25	16	1	1	0	87
Moyamba	55	26	18	1	2	1	103
Port Loko	70	21	15	2	1	2	111
Pujehun	49	14	13	1	0	0	77
Tonkolili	75	15	12	1	1	2	106
Western Area	39	28	39	11	22	10	149
Total	632	319	233	24	45	27	1280

Health Workforce

Number of Community Health Workers (Human Resources for Health Strategy 2017-2021): 15,000
Skilled birth attendance (percent coverage) (Basic Package of Essential Health Services 2015-2020): 62%
Number of skilled providers:
- 3 physicians / 50 nurses per 100,000 population (HRH Strategy 2017-2021)
- 288 midwives in entire country (Basic Package of Essential Health Services 2015-2020)
% of vacant skilled health worker posts (Basic Package of Essential Health Services 2015-2020): 64%
Doctors in-post in entire country (Basic Package of Essential Health Services 2015-2020): 185
Distribution of skills (Basic Package of Essential Health Services 2015-2020): 50% of health professionals are located in Freetown, servicing 16% of population

Health Information Systems

Number of national health training institutions offering clinical and non-clinical masters-level education (HRH Strategy 2017-2021): 25

Access to Essential Medicines

Children aged 6-59 months who received vitamin A supplementation (%) (DHS 2013): 81.6 - 86.1%
Full immunization coverage among one-year-olds (5) (DHS 2013): 62.4 - 73.8%
Children aged <5 years with diarrhea receiving oral rehydration salts (%) (DHS 2013): 81.9 - 88%

Financing

Total expenditure on health per capita (Intl $) (WHO, 2014): 224
Total expenditure on health as percentage of GDP (WHO, 2014): 11.1
Healthcare funders (Global Health Expenditure Database, 2014): 83% domestic / 17% international funding
Healthcare buyers (Global Health Expenditure Database, 2014): 61% spending by household / 17% by government / 22% other
Healthcare buyers (Basic Package of Essential Health Services 2015-2020):
- 61.6% spending by household
- 6.8% spending by government
- 7.2% NGOs
- 24.4% donors
Per capita expenditure in US$: $34 total, $15 government expenditure, $12 household out-of-pocket expenditure
Percentage of total health expenditure provided to facilities in 2013 Basic Package of Essential Health Services 2015-2020):
- 65% to public health facilities (PHU’s)
- 13% to private health facilities, hospitals, pharmacies