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Spot the difference: Sierra Leone free healthcare initiative

Published 05th July 2010 - 5 comments - 8607 views -

Two images of a health centre waiting room

One picture is a waiting room on April 26th 2010 and the other is the same room on April 27th. That’s the day that the government of Sierra Leone made healthcare free for children under 5, pregnant women and lactating mothers.

Do user fees prevent people in developing countries visiting health centres? Well, these results from 5 of Sierra Leone’s 13 districts show there was a 179% increase in children under 5 visiting health centre’s once user fees were dropped. I think the bar chart is really striking.


Graph showing number of outpatients seen by doctors in Sierra Leone

The image below shows people queuing waiting to see a doctor. Following this initial spike, numbers are expected to reduce down (so there won’t be massive queues like there are here). But it illustrates how many mothers don’t visit doctors, even if they think that they, or their child are sick. Looking at these figures, it’s clear that fees are a major barrier preventing poor people visiting health professionals.

Crowd at Ola During


Why did this happen?

Last year at the United Nations General Assembly the then British Prime Minister, Gordon Brown, announced that the UK would support health services in a number of countries, including Sierra Leone. Thanks to that aid commitment the Sierra Leone government announced that they would make health care free for lactating mothers and children under 5. Development aid isn’t the answer to everything but in some cases it has a massive impact.

Next stop, free healthcare for all!

Find out more: When Oxfam went to Downing Street

Figures provided by 'Ministry of Health Statistics' Sierra Leone to Oxfam.


  • Luan Galani on 05th July 2010:

    Nice post, Ian. A great initiative with no shred of doubt.

    In Brazil we do not have user fees for governmental health services. Btw, I will explore it here as soon as I can. But, unfortunately, this service doesn’t work well. There are queues and more queues, there are not enough doctors, and so on. It is a difficult situation most people still endure here.

    Thanks for this.

  • Ian Sullivan on 07th July 2010:

    In this post I was concentrating on user fees but in terms of healthcare a holistic approach is essential - if people don’t have to apy but there are no doctors then that’s a big issue that needs sorting!

  • Maria Kuecken on 08th July 2010:

    Liked the post, Ian. Striking increases. Do you know if the government is planning to eventually erase user fees for the entire population or do they plan on just keeping it as is?

  • Ian Sullivan on 09th July 2010:

    Thanks Maria - for now I think that there is no plan to remove user fees all together. This is simply due to cost. There is currently a campaign in Africa where a coalition of African civil society organisations are pushing their governments to increase health care provision as a % of GDP. Aid money can help with this but I also think African governmetns must do more!

    I’ll research more into that campaign (and Sierra Leone’s position and get back to you!

  • Sylwia Presley on 16th July 2010:

    Brilliant initiative!

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