Fiscal space analysis in Sierra Leone: the free health care initiative and universal health coverage

This brief highlights how Sierra Leone can improve the sustainability of the free health care initiative (FHCI) financing, lower household out-of-pocket (OOP) payments on health care, and decrease its dependence on donors. A secondary analysis provides insights into how Sierra Leone could work towards achieving its longer-term health goal of Universal Health Coverage (UHC). If… Read more




Monitoring and evaluation in Sierra Leone’s health sector

As part of the review of Sierra Leone’s Free Health Care Initiative (FHCI), researchers assessed its monitoring and evaluation (M&E) system, strengths and weaknesses, and the changes that took place as a result of the FHCI. This brief notes that a strong M&E system is crucial to help improve performance and achieve results. Several key… Read more




The free health care initiative (FHCI) in Sierra Leone: real gains for mothers and young children

In 2010, the Free Health Care Initiative (FHCI) abolished health user fees for pregnant women, lactating mothers and children under five. This was a response to very high mortality and morbidity levels among mothers and children and reports that financial costs were a major barrier to health service uptake and use by these groups. This… Read more




Sierra Leone’s free health care initiative: financing implications

In 2010, the Government of Sierra Leone (GoSL) took steps towards establishing the Free Health Care Initiative (FHCI). At its core, this was the removal of user fees (on drugs and consultations) for pregnant women, lactating mothers and children under five. This brief is based on an independent review of FHCI completed in 2016, which looked… Read more




Haja Wurie on incorporating gender into health systems reconstruction in post-Ebola Sierra Leone

Dr Haja Wurie is based at the College of Medicine and Allied Health Sciences in Freetown, Sierra Leone. In this HEART talks video she describes the rebuilding of health systems in the post-conflict period in Sierra Leone as ‘fire-fighting’. This meant that the response did not adequately capture gender. Ensuring service provision for women and… Read more




Rebuilding health systems in conflict-affected states – Sierra Leone

Sierra Leone is almost at the bottom in the Human Development Index, ranking 180th out of 187 countries. There is significant gender inequality where a mere 23% of women are literate, half the rate among men, while domestic violence is widespread. In addition, infectious diseases such as malaria, TB and HIV/ AIDS are the leading… Read more




Impact and implications of the Ebola crisis

The current Ebola outbreak is concentrated in Sierra Leone, Liberia, and Guinea: countries with limited state capacity which are recovering from political instability and conflict. The indirect consequences of the Ebola epidemic and its disruption of public and private services threaten the lives and livelihoods of more than 22 million people in Ebola-affected areas. As… Read more




Increasing the provision of essential health care services through support of health workers in Sierra Leone

DFID committed 12 million GBP to uplift frontline health workers’ salaries in Sierra Leone from 2010 to 2015 to support the implementation of the Free Healthcare Initiative (FHCI), launched in April 2010, which made health services free for pregnant women, children under five years of age and nursing mothers. Increasing the availability of frontline health… Read more




Comparing Responses to the Ebola Outbreak in Northern Uganda and Sierra Leone

In this presentation Barbara McPake, the Research Director of ReBUILD, talks about Ebola in the context of conflict-affected states and health systems with a focus on West Africa – in particular comparing responses to Ebola outbreaks in Northern Uganda and Sierra Leone. The ReBUILD Consortium is a research partnership funded by the UK Department for… Read more




Local beliefs and behaviour change for preventing Ebola in Sierra Leone

‘The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times.  Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long’ (Margaret Chan, 26th September 2014, WHO). This report focuses… Read more




Centre for Progressive Health Financing Scoping Mission

A proposal on how the Centre for Progressive Health Financing can help improve the delivery of pro-poor health services in Liberia The provision of quality and accessible health services to improve the country’s health status is a stated priority of the Government of Liberia. The Ministry of Health and Social Welfare (MoH) has made considerable… Read more




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