By Mahmud Tim Kargbo
Saturday, 14 March 2026
Ten years, hundreds of millions of Leones, and a hospital that still fails to meet basic healthcare needs.
The 2024 Auditor General’s Report paints a stark picture of systemic governance failures in Sierra Leone’s Ministry of Health.
From procurement irregularities to unverified asset management, the report reveals vulnerabilities that could evolve into widespread corruption and seriously undermine public service delivery.
With such inefficiencies entrenched in the Health Ministry, it is increasingly difficult to imagine the government achieving its stated national objectives.
The majority of Sierra Leoneans remain vulnerable to preventable and curable diseases, highlighting a disconnect between public spending and population health outcomes.
A Decade of Mismanagement: The Lumley Hospital Timeline
2014, Contract Initiation
A contract is awarded to Fajaha Construction Company for the construction of Lumley Government Hospital.
Oversight mechanisms are weak, and project monitoring roles are inadequately defined.
2015 to 2018, Slow Progress
Initial construction phases proceed intermittently.
Audit trails show little evidence of milestone reporting or third-party verification.
2019,Partial Completion
Limited progress is made, with unclear budget utilisation.
Internal controls at the Ministry of Health and Directorate of Financial Resources are insufficient to prevent delays.
2020 to 2021, Pandemic Disruption
COVID 19 interrupts oversight.
Project delays continue unchecked.
April 5, 2024,Contract Addendum
An addendum valued at US$679,053.33 is signed to cover additional works funded by the Kuwait Fund.
Previous contractor performance is not formally reassessed.
July 2024, Full Payment Released
Payment for the addendum is made in full within three months, without verification that work has been completed.
This violates procurement best practices.
September 2024, Audit Inspection
Key elements of the construction remain unfinished.
Audit findings expose governance breakdowns spanning a decade.
Reference: Auditor General’s Report 2024, pages 72 and 86
Corruption Risk Network: How Funds Flow in High-Risk Systems
The report identifies a network of vulnerabilities linking contractors, procurement committees, and payment authorisation offices.
Contractor Networks: Receive contracts and advance payments, potential collusion with ministry officials
Procurement Committees: Approve contracts, weak monitoring increases risk of delayed or incomplete projects
Directorate of Financial Resources: Authorises payments, premature disbursements create financial leakage
Treasury Offices: Release funds without proper certification, oversight gaps persist
Audit Service Sierra Leone: Detects irregularities after the fact, recommends corrective measures
Anti Corruption Commission: Investigates misconduct, dependent on audit reporting for evidence
Flow of risk: Procurement irregularities lead to premature payments, then incomplete projects, asset mismanagement, weakened health services, and potential systemic corruption
Reference: Auditor General’s Report 2024, pages 72 and 86
Financial Exposure: Public Money at Risk
Preliminary analysis of flagged expenditures:
Hospital rehabilitation contracts: NLe75,493,118
Advance payments to contractors: NLe21,342,544
Lumley hospital addendum contract: US$679,053.33
Overseas medical payments without verification: NLe3,468,406.80
Assets not verified: NLe1,224,000
Total potential exposure: Over NLe101 million plus US$679,053
Weak financial controls threaten economic efficiency, reduce healthcare productivity, and may increase reliance on international donors
Source: Auditor General’s Report 2024, page 72
Governance Failure Chain
Procurement Weakness: Advance payments and unmonitored contracts create opportunity for misallocation
Payment Verification Breakdown: Full payments issued before completion verification undermine accountability
Financial Traceability Erosion: Direct payments to individuals without documentation facilitate diversion of funds
Asset Control Breakdown: Missing vehicles and unverified assets allow public property to disappear
Service Delivery Deterioration: Shortages of essential medicines and failing infrastructure result
Regional Governance Context
Audit patterns in Sierra Leone mirror early stages of scandals in West Africa
Ghana: Ghost workers in National Service Scheme, procurement irregularities led to multi-million-dollar fraud
Kenya: National Youth Service programme irregularities evolved into full-scale procurement fraud
Nigeria: Health Ministry procurement and payment mismanagement triggered widespread investigations
Reference: Transparency International, UNODC
Strategic Political Implications
Public Trust: Persistent audit findings threaten confidence in the Bio administration’s anti-corruption agenda
Donor Confidence: International partners may impose stricter oversight or reduce funding if irregularities continue
Parliamentary Scrutiny: Recurring findings may provoke intensified oversight and potential political controversy
Reform Momentum: Rapid corrective action can restore credibility, inaction may institutionalise governance weakness
Human Capital vs Health System Reality
President Bio has campaigned to prioritise human capital and aims to be remembered as a “Human Capital President.”
Official government sources cite a Human Capital Index Plus score of 117, above the low-income country average, noting improved child survival, nutrition, and life expectancy.
Yet the audit paints a very different picture on the ground:
Essential drugs are missing from peripheral health units
134 health facilities in Kenema District are served by only two inadequately equipped ambulances
Hospital infrastructure projects remain incomplete after years of budgeted spending
The questions this raises are profound and uncomfortable:
How can international rankings claim progress if the majority of citizens are not feeling health improvements?
Are official health sector metrics being manipulated to satisfy donor expectations while actual beneficiaries receive no tangible benefits?
To what extent are funds channelled through complex networks that benefit a few insiders while the population continues to suffer preventable illnesses?
Can the government claim to build human capital when curable diseases still claim lives due to weak health infrastructure?
Behind every data point is a child, a mother, a family.
If these families are still exposed to preventable mortality and poor access to care, the effectiveness of reported health improvements must be questioned.
Reference: Government of Sierra Leone, Chief’s Diary; World Bank Human Capital Index Plus: https://humancapital.worldbank.org/hciplus/
The Lumley Hospital project illustrates how procedural lapses can accumulate over a decade into systemic governance risk.
From procurement failures to unverified payments and missing assets, the Ministry of Health’s administrative weaknesses have tangible consequences for healthcare delivery and public confidence.
Audit reports are not merely bureaucratic exercises.
They are early warning systems.
Their findings, if acted upon decisively, can prevent minor mismanagement from escalating into full-blown financial and institutional crises.
For Sierra Leone, the next steps will determine whether these warnings translate into reform or become lessons learned too late
References
Audit Service Sierra Leone, 2024 Auditor General’s Report: https://www.auditservice.gov.sl
Anti Corruption Commission Sierra Leone: https://www.anticorruption.gov.sl
Ministry of Finance, Sierra Leone, Public Financial Management Act 2016: https://mof.gov.sl
National Public Procurement Authority, Public Procurement Act 2016: https://www.nppa.gov.sl
Transparency International: https://www.transparency.org
United Nations Convention Against Corruption: https://www.unodc.org/unodc/en/corruption/uncac.html
World Bank Human Capital Index Plus: https://humancapital.worldbank.org/hciplus/
World Bank Governance Indicators: https://info.worldbank.org/governance/wgi
World Bank Public Financial Management Research: https://www.worldbank.org
African Union Convention on Preventing and Combating Corruption: https://au.int/en/treaties/african-union-convention-preventing-and-combating-corruption
Commonwealth Charter: https://thecommonwealth.org/our-charter