By Jarrah Kawusu-Konte
“Lack of Doctor, No Proper Diagnosis, No Dignity: The Systemic Rot in Sierra Leone’s Health Infrastructure”
Gbonkomaria, Kambia District — As dawn breaks, 54-year-old Alhaji Bockarie prepares to board a motorbike for the long journey to Kambia Government Hospital. His wife has been bleeding heavily for two days. The local health post in Gbonkomaria, like hundreds across the country, lacks a midwife, a blood pressure monitor, and even cotton wool. There is no ambulance. The nearest functional clinic or hospital is miles away.
Across Sierra Leone, the very basics of modern health care, doctors, diagnostics, safe buildings, and sanitation, are in dangerously short supply. And no matter how well-written the policies, when the infrastructure is broken and the workforce demoralized, health becomes a privilege, not a right.
Health Financing in Free Fall
Despite the government’s repeated commitments to better health services,” health financing has remained woefully inadequate and donor-dependent. In 2022, the Government of Sierra Leone allocated just 8.7% of its national budget to health, far below the 15% Abuja Declaration target agreed by African heads of state in 2001. According to the World Bank, over 46% of health financing still comes from external donors, raising sustainability concerns.
“The current health budget is an insult to our aspirations,” said a Honourable Member of Parliament from Kambia district in a 2023 parliamentary session. “We can’t keep blaming the war or Ebola. The problem is priority.”
Dr. Ibrahim Bangura agrees. “We spend more on fueling luxury vehicles than equipping district hospitals,” he said to supporters in Kono. “This is more than a financial crisis. It is a leadership crisis.”
Distance, Delays, and Death: Barriers to Access
In rural Sierra Leone, distance to health facilities is a death sentence. According to UNICEF’s 2023 Sierra Leone Country Health Assessment, more than 40% of communities are located over 10 kilometers from the nearest health facility, often without roads, transport, or mobile coverage. Even when a facility exists, it may be manned by only one health worker, and closed poorly run due to lack of incentives, illness, or lack of supplies.
“The only nurse in our PHU is also the cleaner, the dispenser, and the security,” said a woman in Mongo Bendugu. “If she travels, the clinic dies.”
Critical Shortages in the Health Workforce
Sierra Leone’s health workforce is among the most understaffed and overstretched in the world.
As of 2023, the doctor to patients ratio in Sierra Leone remains as grim as it can get:
Doctors: 1 per 24,000 citizens (WHO recommends 1:1,000)
Nurses and midwives: 1 per 6,500
Pharmacists: 1 per 34,000
Specialists in rural areas: Often zero.
A 2021 MoHS-HRH Directorate Report revealed that 80% of trained anaesthetists, paediatricians, and obstetricians were concentrated in Freetown. District hospitals in places like Pujehun, Falaba, and Karene had no specialists at all.
Owing to poor conditions of service, Sierra Leone continues to suffer from brain-drain, more so in the health sector with over 300 health professionals reportedly emigrating to the UK, Middle East, and Gambia between 2021–2024 due to poor pay, lack of housing, and zero career progression.
“We’re losing our best to countries that value them,” lamented a senior obstetrician. “And who suffers? The poor woman in Tikonko, the child in Bumbuna.”
Infrastructure without Integrity
Walk into most government health facilities, and the picture is grim: crumbling walls, broken toilets, leaking roofs, rusted beds, dusty laboratories, and piles of uncollected medical waste. A 2022 audit by the Health Sector Performance Monitoring Team revealed that:
53% of health centers had no functioning laboratory equipment
68% had no oxygen supply
Only 11% had emergency transport for referrals
Over 70% lacked regular water supply
Hygiene remains a public health scandal. At a maternity ward in Kenema, mothers and newborns share beds. Mosquitoes buzz overhead. Bloodstained sheets remain unwashed for days.
A visiting EU delegation member, after inspecting a facility in Bonthe, told local press: “We are stunned. This is not a hospital. It is a trap.”
Low Morale, High Stakes
The consequence of poor working conditions, insecurity, and lack of recognition is low morale across all cadres of health workers. From nurses and lab technicians to junior doctors and pharmacists, everyone has a grievance. Salaries are late. Risk allowances are missing. Retirement benefits are paltry and often disappear into bureaucratic black holes. As a 2023 Occupational Satisfaction Survey concluded: “There is a pervasive sense of abandonment among Sierra Leonean healthcare professionals.”
Expert Perspectives and Policy Lessons
The failures in Sierra Leone’s health system echo the writings of Amartya Sen, Nobel Laureate and development theorist, who warned that “poverty is not just lack of income — it is a deprivation of capabilities.” Health is one such capability.
Paul Farmer, in his seminal work “Pathologies of Power”, described systems like Sierra Leone’s as forms of “structural violence”, not accidental suffering, but predictable and politically enabled neglect. International partners, including Irish Aid and the Global Fund, have repeatedly emphasized the need for robust domestic investment, health systems strengthening, and equity-based planning, not merely donor-funded projects.
A Political Solution: Where Leadership Begins
We will not build a healthy Sierra Leone through slogans and spreadsheets. It starts with political courage. We must start this process with the election of Dr Ibrahim Bangura as APC flagbearer.
“We don’t need magic,” Bangura said. “We need momentum. That begins when the APC delegates choose to elect leaders for solutions.”
Conclusion: Choosing Health, Choosing Life
In every corner of Sierra Leone, from Kailahun to Kambia, citizens know what it means to walk for miles only to be told: “Natin nor dey.” It is a phrase that has come to define this administration’s health legacy. But it doesn’t have to define the future. With the right leadership, Sierra Leone can restore dignity to its health sector, reward its health workers, and reimagine clinics as places of healing, not hopelessness.
As Dr. Bangura reminds us: “When politics fails, people die. But when politics gets it right, even the smallest clinic can save a nation.”
