Sierra Leone

It’s an irony that Sierra Leone, one of the poorest countries in the world — decimated by 11 years of civil war, with one of the highest levels of infant mortality anywhere — is where we’ve achieved one of our biggest breakthroughs.


Young mothers sit in the waiting room of the Kroo Bay Community Health Centre, Sierra Leone

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Here, where dirt roads make it difficult for us to get textbooks to schools in the rainy season, and some girls sell themselves to survive, we have a shining example of what happens when everyone aims at a single goal.

The government, our policy officers, ordinary Sierra Leoneans, international donors, a wealthy individual, and Sierra Leonean health professionals all came together to do one thing: save children’s lives.

And it worked.

  • 1.5 million children and their mothers now have access to free healthcare, thanks to a government decision announced in April 2010. We played a crucial role in making it happen.
  • More than 21,000 children have a better education thanks to our work in 59 schools.

The challenges

It’s at the bottom of world tables for infant mortality, mothers’ survival in childbirth, and the availability of clean water.

In one district where we work, more than 60% of teachers are unqualified and untrained.

In the classroom, children are beaten when they can’t answer a question.

Girls routinely undergo female genital mutilation, marry young and have babies before they are ready.

Survival is a game of chance, with the poorest losing.

Yet Sierra Leone is where we’ve seen one of our biggest breakthroughs.

What we’ve achieved

1.5 million children and their mothers now have access to free healthcare — a stunning decision announced by the government of Sierra Leone at the UN General Assembly in September 2010, and launched in April 2011.

As a result, the use of health facilities to treat children for malaria, diarrhoea and pneumonia rose threefold.

It’s too soon to know how many lives will be saved, but we know from our own clinics that free healthcare means that children get the help they need.

It was the government’s decision to stop user fees, but it took a lot of people to get there.

  • Our team in Kailahun noticed that user fees were keeping mothers and babies from essential health services when we started working there in 2006. They began to campaign for free healthcare.
  • Our advocacy team built up evidence and lobbied governments, international agencies and donors.
  • In our clinics, we demonstrated how much better care could be if it were free — thanks in large part to the contribution to 35 clinics and emergency obstetrics by one of our major donors and support from the National Lottery.
  • We took it public with a mass campaign. Tens of thousands of Sierra Leoneans raised their hands to say no to needless child deaths.
  • Working with the government, we helped devise a strategy for free healthcare.
  • We lobbied the British government and other major donors to make the contributions to enable the Sierra Leone government to boost health spending.

“This project will be remembered for its impact on all mothers and children in the whole of Sierra Leone,” said an independent evaluation of our health work.

We are also proud of our achievements in child protection and education.

As a result of our work in communities, one chief banned female genital mutilation for girls under 18 years old, another stopped the marriage of girls at a very young age.

We are helping the government to strengthen the child protection system, in part by rolling out the new Child Rights Act.

More than 20,000 children got an education because of our work in 2010.

Teachers we’ve trained have better relations with their students and are less likely to use abuse. “They don’t flog us here if we cannot answer,” one child from a Save the Children-supported school told us.