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 brief highlights that FHCI triggered some real gains in the health system such as revitalised structures for sector governance; increased staffing; and better systems for staff management and pay, and for getting funds to the facilities. New monitoring and evaluation systems were introduced and facility audits conducted; infrastructure improved from a very weak starting point; and a communication campaign was initiated with resulting high population awareness.

Further, more financial resources led to a prioritisation of maternal and child health programmes and to some degree a switch from household to donor spending. Household spending as a proportion of total health expenditure went from 83 per cent in 2007 to 62 per cent in 2013. Donor funding went from a low of 12 per cent in 2007 to a high of 32 per cent in 2013.

For other reports in this series on Sierra Leone’s Free Health Care Initiative, see:

• Sierra Leone’s free health care initiative: financing implications
• Monitoring and evaluation in Sierra Leone’s health sector
• Fiscal space analysis in Sierra Leone: the free health care initiative and universal health coverage