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 at financing changes following the initiative’s launch, and focuses on the pre-Ebola outbreak years (2010-2013). It outlines how financing flows changed, and highlights some of the major strengths and weaknesses in resourcing the initiative.

In putting forth several recommendations, the brief notes, that the government should prepare a health financing strategy which outlines: a plan for future donor expenditure; a plan for increasing pre-financed domestic expenditure on health; a plan for improving the efficiency of existing expenditure on health; and a set of solutions that help align and coordinate government and donor funding.

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

• The free health care initiative (FHCI) in Sierra Leone: real gains for mothers and young children
• Monitoring and evaluation in Sierra Leone’s health sector
• Fiscal space analysis in Sierra Leone: the free health care initiative and universal health coverage