By Mahmud Tim Kargbo
Saturday, 11 April 2026
Sierra Leone’s health sector continues to face profound challenges, as declining budget allocations, systemic inefficiencies, and weak accountability combine to produce a reality in which preventable diseases still claim lives across the country.
The government’s 2026 allocation to the health sector stands at NLe 1.4 billion, representing approximately 8 percent of total public expenditure. This reflects a decline from the 2025 figure of around NLe 1.5 billion and remains significantly below the 15 percent target set under the Abuja Declaration, a commitment adopted by African Union member states to prioritise health funding.
https://au.int/en/abuja-declaration
Within this allocation, NLe 42.2 million has been earmarked for Free Health Care drugs. While this provision is critical, health professionals warn that it is insufficient to meet the demands of a growing population and an already overstretched system.
A review of funding trends shows that health expenditure peaked at NLe 1.7 billion in 2023 before declining steadily. This inconsistency undermines long term planning and weakens the ability of the system to respond effectively to both routine care and emergencies.
However, beyond budgetary concerns lies a deeper issue of legal and moral responsibility.
Under Sierra Leone’s constitutional framework, the state is obligated to promote the welfare of its citizens, including access to healthcare. Section 8 of the Constitution of Sierra Leone emphasises the state’s duty to provide adequate medical and health facilities for all persons.
http://www.sierra-leone.org/Laws/constitution1991.pdf
This obligation is further reinforced by international commitments. Sierra Leone is a signatory to the International Covenant on Economic, Social and Cultural Rights, which recognises the right of everyone to the highest attainable standard of physical and mental health.
https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-economic-social-and-cultural-rights
In addition, successive government manifestos have consistently pledged to strengthen healthcare delivery, expand access, and improve infrastructure. These commitments position healthcare not as a discretionary policy area, but as a core responsibility of governance.
Yet the lived reality tells a different story.
At a community health centre in a rural district, a nurse described the daily challenges faced by frontline workers.
“We often run out of essential drugs before the end of the month,” she said. “Patients come in with malaria or infections that we know how to treat, but sometimes we simply do not have what we need. It is frustrating because these are not complicated cases.”
Her experience reflects a broader systemic issue. According to the World Health Organization, preventable diseases such as malaria, respiratory infections, and maternal complications remain leading causes of death in low resource settings, where health systems are underfunded.
https://www.who.int/news-room/fact-sheets/detail/malaria
For patients, the consequences are immediate and personal.
A mother in a provincial town recounted losing her child after a delay in receiving treatment.
“We were told to buy the medicine outside because the hospital did not have it,” she said. “By the time we found the money and came back, it was too late.”
Such stories are not isolated. They are emblematic of a system where gaps in funding and delivery translate directly into loss of life.
Beyond the immediate human cost, the persistence of such deplorable conditions within health facilities continues to undermine the broader human capital development ambitions of the Bio led administration. Health is a foundational pillar of productivity, education, and national growth. A population burdened by preventable illness cannot fully participate in economic activity, nor can it sustain gains in education and skills development.
This reality stands in direct tension with the government’s stated Big Five agenda, within which human capital development occupies a central place. The continued deterioration or stagnation of health service delivery risks eroding progress made in other sectors, as poor health outcomes reduce workforce efficiency, increase dependency, and weaken long term national competitiveness.
Comparative evidence from across Africa demonstrates that improvement is possible where political commitment aligns with sustained investment.
Rwanda has invested consistently in healthcare, particularly at the community level, resulting in significant reductions in maternal and child mortality and improved overall health indicators.
https://www.worldbank.org/en/country/rwanda/overview
Ivory Coast has also made notable progress in expanding health infrastructure and strengthening service delivery, supported by increased public investment and reforms aimed at improving access to care following years of instability.
https://www.worldbank.org/en/country/cotedivoire/overview
Ghana has strengthened access through its National Health Insurance Scheme, reducing out of pocket costs and improving service utilisation.
https://www.who.int/countries/gha/
These examples illustrate that sustained investment, combined with effective governance, can yield measurable results.
However, development organisations have raised deeper structural concerns across West Africa. Oxfam has warned that many governments in the region continue to prioritise servicing international debts over meeting the basic needs of their populations, including healthcare. This imbalance, it argues, contributes directly to inequality and weak public service delivery.
https://oxfamilibrary.openrepository.com/bitstream/handle/10546/620837/bp-west-africa-inequality-crisis-090719-en.pdf
In Sierra Leone, these pressures are compounded by domestic challenges. Health facilities remain inadequate, especially in rural areas. There is a chronic shortage of trained medical personnel. Supply chains are often unreliable, leading to frequent shortages of essential medicines. Concerns around transparency and the efficient use of resources further compound the problem.
Even well intentioned initiatives such as the Free Health Care programme, designed to support vulnerable populations, are often constrained by delayed funding and logistical inefficiencies.
The gap between policy and practice is therefore stark. On paper, commitments exist. In reality, delivery remains inconsistent.
Addressing this crisis requires decisive and sustained action.
First, the government must increase health sector funding towards the Abuja benchmark in a structured and predictable manner. This is not merely a financial decision, but a fulfilment of constitutional and international obligations.
Second, accountability mechanisms must be strengthened. Transparent budgeting, independent audits, and effective oversight are essential to ensure that resources reach frontline services.
Third, primary healthcare must be prioritised. Investment in community based systems, preventive care, and early intervention can significantly reduce mortality rates.
Fourth, the health workforce must be expanded and supported. Training, fair remuneration, and retention strategies are critical to improving service delivery.
Finally, improvements in supply chain management and the adoption of digital health systems can enhance efficiency and reduce wastage.
International partners can support these efforts, but the primary responsibility lies with national leadership.
The evidence is clear. The commitments are known. The solutions are within reach.
What remains in question is whether the necessary political will exists to act decisively.
Until that happens, Sierra Leone’s health crisis will not be defined by a lack of knowledge, but by a failure to translate responsibility into action.