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The state of hospitals in Sierra Leone

By Allieu Sahid Tunkara, Freetown

Sierra Leone health sector takes pride in 22 referral hospitals and 1,200 peripheral health units across the country. The structural arrangement of the health system places responsibility on the hospitals to take care of major ailments including surgical operations while the PHUs which include community health centres and maternal child health posts provide basic medical services to the communities in which they operate.

Referral hospitals are manned by Medical superintendents answerable to the District Medical Officers. The peripheral health units are located in remote communities and are manned by Community Health Officers or   Community Health Assistants depending on the population of a particular locality. Almost all government hospitals have Maternal and Child Health Aides who are being trained by medical doctors. The current staff strength puts the strength is 6,ooo serving a population of 3,000,000 people. This figure is filled with mostly nurses and health volunteers who give a helping hand to the country’s deplorable health system. The hospitals are understaffed as the right personnel are not posted to these hospitals. Even the sanitary condition of the hospitals is nothing to write home about. The shortage of health personnel has led to the volunteerism syndrome which is visible in all hospitals in the country.  Majority of these volunteers who hold no medical qualification step in to lessen the visible shortage of health professionals in the country. Although medical doctors are doing their own part, several specialist doctors are missing and  this create a situation in which Sierra Leoneans have to travel to advanced countries like the US, the UK, France and countries in Africa like Ghana to seek quality medical service for serious health problems beyond the knowledge of Sierra Leonean medics.

Many assurances have been made by government to improve the medical situation the situation in the country, but the pitiful situation continues unabated.


The Fibre Optic Cable project that has been largely discussed in the country’s media was one of the ambitious projects pursued by the government. One of the benefits of these projects if it is materialised is the exchange of the medical knowledge and experience between Sierra Leone and countries with advanced medical services. This project is yet to come to fruition.

Sierra Leone is one of the many African  countries that participated  in the African Union (AU) summit  in Nigeria in 2001 that led to the signing of the ‘Abuja Declaration’ in which, like other African nations, it committed itself, to allocate 15% of its national budget to the health sector as way of improving the sector.


Since the government made such commitment, Sierra Leone health system has still been grappling with budget constraints which have devastating consequences on the sector. In 2010, the sector received 8% budgetary allocation, in 2011, it received 12%, in 2012, 10.5%, in 2013, 9.5% and currently the budgetary allocation sands at 7.5%.

The programmes Manager of ‘Health Alert’ who read out these figures is of the firm view that the country will not attain the 15% target as almost all funds are now directed to the Ebola eradication campaign. Low budgetary allocation alongside bottlenecks in budget implementation means that the country’s health sector is not enjoying the appropriate financial requirements. This is evidenced by the lack of sufficient drugs in hospitals and personal protective gears. Alie Dawoh is the a health officer in charge of the Cold Room store of the government drug store at New England, West of Freetown. He explained that there is no rabies injection in the drug store. He explained that in most situations, he purchases these injections and use them on victims of dog bites who frequently report to the drug store for help. Congo Cross and New England Communities have suffered a number of dog-bite related cases and most of them have died. Apart from dog bite related cases, even ‘tracer drugs’, including panadol, were most times not available in the health facilities. The international community had once rated Sierra Leone as one of the countries with the highest maternal and infant mortality rate and therefore the least in the bottom rungs of the human resource development index.

Government hospitals are run on a cost recovery basis as patients pay for the drugs and other health services they enjoy. In government hospitals, people pay less as compared to private hospitals. In many cases people have argued that private hospitals provide quality service than government-run hospitals. This therefore explains that access to quality service is conditioned by one’s earning power. In the Government main health facility in Freetown (Connaught hospital), the accommodation for the high income earners is different from low income earners. The attitudinal and behavioural disposition of health officials also scares away patients from the hospitals. Nurses are less patient with their clients as they often shout at them. The communications officer for the Health Ministry, Jonathan Abass Kamara, acknowledge that nurses put on the wrong attitude towards patients although there is a code of ethics guiding the Nursing profession. ‘Those nurses, mostly the senior nurses who comply with the ethics of the profession are referred to as the Florence Nightingale, the founder of nursing while nurses who flout the ethics are called the millennium nurses,’ Kamara explained. However, the nursing directorate of the Ministry of Health and Sanitation headed by the Chief Nursing Officer, Hossanatu Kanu, Abass Kamara explains, is working very hard to weed out some of the nurses who embarrassed patients.

Sierra Leone’s health sector is riddled with corruption which threatens the pillars of the medical profession. Nurses’ penchant for bribe taking has been a hot topic of discussion one within public domain. It is no longer secret that nurses demand bribes from patients, especially the beneficiaries of the free health care. Theft of drugs from hospitals is commonplace. The Ministry of Health and civil society organisations have expressed concerns over such conduct.  They say, although they have received reports of such malpractice malpractice, there is no evidence to corroborate to such allegations. They are on the watch out. However, there was a situation in Pujehun in which health officials at the Pujehun government hospitals were arrested and dragged to court for alleged theft of huge medical supplies that nearly wrecked the hospital. One of the accused persons was a pharmacist called Lahai Koroma, Aka Oga Lahai who was attached to the hospital. With the exception of a labourer who was freed, all of them were convicted, including the pharmacist. Few years back, a truckload of free health care drugs were arrested in Kambia very close to the Sierra Leone-Guinea border. The drugs were loaded in a pick-up van allocated to the Kambia government hospital when they were about to be diverted to Guinea.

The smugglers ran out of luck as they were apprehended by police officers of the Sierra Leone Police. Whether those suspects were tried or not, only God knows. No government official has come out to say a word in respect of the arrest.

As it stands, The College of Medicine and Allied Health Sciences, a constituent college of the University of Sierra Leone and few paramedical schools in the provinces produce health officials who are battling with the country’s health system. Strong policy and legal framework for the health sector and appreciable budgetary allocation can provide the right answers for Sierra Leone’s fledgling health sector. This can be made possible if government shows strong political commitment and health officials cooperate.

This report was done in collaboration with Ouestaf News with the support of Osiwa 

(C) Politico 30/06/15