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Sierra Leone: celebrating two years of the Free Health Care Initiative

A couple of weeks ago we saw Charles Taylor was convicted of terrible war crimes in Sierra Leone.

The next day, 27 April, gave us an opportunity to celebrate how far the country has come since the days of civil war, with the second anniversary of the launch of the Free Health Care Initiative (FHCI).

When Ernest Bai Koroma became President of Sierra Leone in 2007, he inherited a country with the worst child mortality rate worldwide: one in four children died before the age of five.

With about half the population living on less than a dollar a day, the majority of households couldn’t afford to access healthcare.

Making healthcare free for women and children

The President made maternal health his top priority. Two years ago, he launched the FHCI, making healthcare for pregnant and lactating women and children under five free at the point of use. (Read a blog on this by Mr Koroma in the Huffington Post)

He instigated a planning process that helped to prepare the health system to manage increased demand.

This included better pay for health workers and purchasing more drugs.

Quoting Rob Yates from Britain’s Department for International Development (DFID) said, “the planning was more thorough than any I have seen. Other governments can learn from Sierra Leone”.

Dramatic impact

Goderich Health Centre, before and after the launch of the FHCI (pictures courtesy of Rob Yates)

Overnight, attendance at health facilities increased dramatically.

Here are some photos taken the days before and after the launch.

We can see what was an empty clinic become full of women and children accessing healthcare just two days later.

As the former Head of DFID in Sierra Leone, Dominic O’Neill, himself said, the FHCI “has saved thousands of women and children and ensured that Sierra Leone is no longer the most dangerous place in the world to be a mother”.

Watch this brilliant video the government has made in collaboration with our colleagues in Sierra Leone.

Implementing such reforms are no doubt challenging, and as hurdles are identified, efforts are made to address them.

For instance, there were problems with drug availability at facilities; UNICEF is now working with the government to try to address this.

Political will and courage

As the World Health Organization has asserted, user fees are the most unfair way of financing healthcare, deterring the poor from accessing care and exacerbating poverty.

Worldwide 150 million people face catastrophic expenditures due to healthcare, plunging 100 million into poverty each year. This was acknowledged by the President and acted upon with the FHCI.

President Koroma’s leadership has been key to making the FHCI happen – as documented by a recent Princeton brief, and donors followed suit.

Donor support is key

The support of DFID and other donors has been, and continues to be, crucial.

While the government works to establish a more holistic health financing policy this year, supporting the FHCI and extending financial risk protection to the rest of the population, continued donor support is essential.


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