Find Health and Medical expertise in Sierra Leone

There are about 80 hospitals in the public and private sectors in Sierra Leone. The facilities include 17 government civilian hospitals, with a key private hospital, Choithram, in Freetown. Other, temporary hospitals have been opened to treat Ebola patients, usually funded by charities or foreign governments. The largest mission hospital in the country is the Emergency Hospital established by the Italian non-governmental organisation (NGO) Emergency, and a key medical training facility is the College of Medicine and Allied Health Sciences (COMAHS). There is also a thriving market for traditional healers in Sierra Leone.

The Hospital Boards Act 2003, followed by the Hospital Boards Amendment Act 2007, came into operation to ensure the better management of specified hospitals and the provision of efficient medical care in the country. In 2010 the government brought in the Free Healthcare Initiative for pregnant women, breastfeeding mothers and children under five. Fees for medical attention were abolished for these target groups, with drugs and treatment provided free of charge in every public health facility in the country.

Health care infrastructure was severely damaged during the country’s civil war. Many clinics were looted. International charities, such as the Red Cross, are still very active in Sierra Leone, helping to plug gaps in health care until long-term improvements can be made.

A fledgling pharmaceutical industry has sprung up in the last few years, but the country still imports the vast majority of its drugs, with the Pharmacy Board monitoring the quality of incoming medicines. Sierra Leone’s pharmaceutical sector mainly consists of retailers, marketers and local agents of the big international pharmaceutical firms. The Pharmacy Board has been involved in a series of efforts to stamp out the proliferation of counterfeit medicines, which continue to pose a threat to the pharmaceutical industry and public health in the entire region.

Ebola outbreak

The Ebola outbreak of 2014–15 has claimed 3,687 lives in Sierra Leone so far, according to the World Health Organization (WHO; March 2015). The first confirmed case in Sierra Leone was in May 2014, the outbreak having begun in Guinea several months earlier. The international response was headed by the United Nations and the WHO, with many charities and national governments pledging funding and medical personnel to help combat the crisis. The UK has opened six Ebola treatment centres across Sierra Leone, sending hundreds of UK doctors, nurses and other medical professionals to help treat patients and educate communities about preventative measures.

Communicable diseases along with maternal, perinatal and nutritional conditions in Sierra Leone accounted for an estimated 66% of all mortality in 2012. The prevalence of HIV/AIDS in Sierra Leone, as a percentage of people aged 15–49 years, stood at 1.4% in 2014. The prevalence of HIV/AIDS in Sierra Leone increased consistently from 1990 before plateauing in 2007. In 2012 there were a reported 1,537,322 cases of malaria in the country. Malaria has seen a rapid increase in the number of deaths and confirmed cases since 2005, although these figures did begin to decrease in 2010. In the period 1990–2010 there was a gradual and consistent increase in estimated incidence of tuberculosis (TB), while estimated mortality (when mortality data excludes cases comorbid with HIV) from this disease decreased in the same period. Non-communicable diseases (NCDs) in Sierra Leone accounted for an estimated 26% of all mortality in 2012. The most prevalent NCDs in Sierra Leone are cardiovascular diseases, which accounted for 9% of total deaths across all age groups in 2008. Cancer, non-communicable variants of respiratory diseases and diabetes each contributed 2% to total mortality (2012).

Government expenditure

Less than a fifth of health care in Sierra Leone (17%) was government funded in 2012. The remaining 83% was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted 15.1% of GDP in 2012. Expenditure by government amounted to US$16 per capita.

In 2013 government expenditure on health was 1.6% of GDP. In the most recent survey, conducted in the period 1997–2010, there were two doctors, and 17 nurses and midwives per 100,000 people. Additionally, in 2010, 61% of births were attended by qualified health staff and in 2013, 83% of one-year-olds were immunised with a dose of measles. In 2014, 62% of people were using an improved drinking water source and 13% had access to adequate sanitation facilities. The most recent survey, conducted in the period 2000–11, found that Sierra Leone has three pharmaceutical personnel per 100,000 people.

Infant mortality in Sierra Leone was 107 deaths per 1,000 live births in 2013, with an under-five mortality rate of 161 deaths per 1,000 live births in 2013. There has been a consistent decline in the under-five mortality rate since 1993. Although this decline is encouraging, the under-five mortality rate is not yet in line with the country’s target of 89 deaths per 1,000 live births as defined by Millennium Development Goal 4 (MDG 4). In 2010 the three most prominent causes of death for children below the age of five years were acute respiratory infections (17%), malaria (14%) and diarrhoea (14%). Other contributory causes were prematurity (9%), intrapartum-related complications (9%), measles (6%), neonatal sepsis (5%), congenital anomalies (4%) and injuries (4%). In 2013 Sierra Leone had an adjusted maternal mortality ratio of 1,100 deaths per 100,000 live births (this figure was estimated at 890 deaths per 100,000 by UN agencies/World Bank in 2010).

Sierra Leone was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1996 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination.