Freetown – Twenty-five-year-old Yainkain Sesay is expecting her first child. Before her first antenatal visit to King Harman Maternity and Child Hospital in Freetown, Sierra Leone’s capital city, she was anxious. “When I visited the hospital before I was pregnant, it was hard because I couldn't afford to pay for all the treatment,” she says. But when she returned this time, she was pleasantly surprised. “The health services here are good and I feel safe. They don't ask for money and they provide good treatment. Pregnant women like me are treated well.”

The change that Sesay has experienced is due to continuing efforts by government to promote the right to health for all people in the country. A new strategy, developed by the Government of Sierra Leone with support from World Health Organization (WHO) and launched in May 2023, aims to entrench a people-centred life stages approach to health care, strengthening health systems and advancing the country towards universal health coverage (UHC). 

“The person-centred life stages approach seeks to provide holistic one-stop care for clients, through integration of services and mechanisms. It requires investment in primary health care systems to provide health promotion, disease prevention, curative, rehabilitative and palliative services at all life stages, leaving no one behind,” explains Dr Austin Demby, Sierra Leone’s Minister of Health.

According to data from WHO, in 2021 the UHC service coverage index in Sierra Leone was 41 out of 100, a medium ranking. The service coverage index uses a selection of indicators to represent overall coverage of essential health services across the entire population in a country, ranked from zero (worst) to 100 (best) and is used to measure progress towards the Sustainable Development Goals related to UHC.  Sierra Leone’s has almost tripled since 2000, when it was ranked very low at 14 out of 100. The country has made efforts to improve health services amid challenges including the devastating Ebola outbreak in 2014 and the COVID-19 pandemic, which stretched the health system to the limit.

This improvement is in part thanks to Government’s free health care for pregnant women, lactating mothers and under-5 children since 2010. With the new strategy, government aims to accelerate progress towards its ambitious 2030 goal, which is that all people in Sierra Leone will have equitable access to quality and affordable health services without any undue financial hardship.

The approach is being rolled out to cover the whole country. The Community Health Officer at the Waterloo Community Health Centre in Freetown, Emmanuel Marcathy, says that in the past year the centre has made significant changes that are encouraging patients back in large numbers.

“One of the key issues we identified was the inadequacy of the facilities to support patients. We focused on improving staff attitude and upskilled nurses in various clinical procedures. The free health care programme is thriving in our facility, with consistent drug supplies, particularly for people like under-5 children, pregnant women and lactating mothers,” he says.

Mariama Bah, a midwife at King Harman Maternity and Child Hospital, is grateful to witness the extensive infrastructure changes and repairs that she says have transformed care. Among these are improved drug availability and testing capacity, sufficient beds and improved support, especially for pregnant women.
“Over the past two years in the new building, the hospital proudly recorded zero maternal deaths, reflecting our commitment to quality health care, despite the challenges we face,” Bah says.

The country has taken other steps to put policy into action. In May 2023, the government worked closely with WHO to conduct a Universal Health Preparedness Review, a process designed to bolster health emergency preparedness and response, while simultaneously building health system capacity to deliver quality universal health care. One of the recommendations of the review was to establish a national public health agency, a pivotal step in the country’s journey towards UHC. Seven months later, in December 2023, the country launched the agency, a foundational institution that will provide science-based leadership, expertise and coordination for public health efforts.

Commending the Government of Sierra Leone for the significant achievements in improving health and well-being since the 2014 Ebola outbreak, WHO Representative in Sierra Leone, Dr Innocent Nuwagira, is upbeat about the progress being made. “Government is committed to the process. We have seen remarkable change, high-level commitment and partner collaboration,” he says. “WHO will continue to support the government towards meeting the set targets as we advance to the year 2030.”

It has been a long and complex process of identifying gaps and strengths, and this has translated into many opportunities for improvement, says Dr Demby. “We must ensure the availability of strong programmes throughout the life course, while superimposing on that a system for early detection and effective response to outbreaks and emergencies. Those are all the hallmarks of the universal health coverage,” he says.

For users like Sesay, the changes have brought about a sense of peace for the future. “Since I registered at the hospital as a pregnant woman, I've never regretted it. I look forward to delivering here safely,” she says.