Sierra Leone has taken a crucial step toward achieving Universal Health Coverage (UHC).
On May 6, 2025, the Ministry of Health, with support from the World Health Organization (WHO), hosted a high-level policy dialogue on the draft Sierra Leone Agency for Universal Health Coverage (SLAUHC) Bill.
This vital engagement in Freetown brought together over 60 senior leaders, including ministers, directors, and technical heads from across the health sector.
The proposed SLAUHC Bill aims to establish a dedicated agency that will integrate and manage two major national health financing mechanisms: the Free Healthcare Initiative (FHCI) and the Sierra Leone Social Health Insurance Scheme (SLeSHI). This unified governance structure seeks to address existing fragmentation, enhance the efficiency of health financing, and accelerate the nation’s progress towards UHC.
“This Bill is a transformative step in Sierra Leone’s journey toward sustainable health financing,” stated Dr. Ibrahim F. Kamara, speaking on behalf of the WHO Country Representative. “It will strengthen institutional capacity, enhance accountability, and ensure equitable access to health services, particularly for the most vulnerable populations.”
The dialogue focused on three key objectives: comprehensively reviewing the draft legislation, building consensus among stakeholders, and aligning the bill with the Ministry of Health’s UHC Roadmap and SLeSHI implementation framework. The outcome is a consolidated and informed policy position, paving the way for the bill’s submission to the Inter-Ministerial Committee (IMC).
Chief Medical Officer Dr. Sartie Kenneh stressed the importance of a holistic approach to UHC. He highlighted that while health financing is critical, it’s only part of the solution. “No healthcare service is truly free, while it may be free at the point of delivery, someone ultimately bears the cost,” Dr. Kenneh noted. He advocated for designing a sustainable health financing model and allowing the FHCI and SLeSHI to operate in tandem to optimize coverage and address the full spectrum of healthcare costs.
Addressing Deep-Seated Challenges
The proposed SLAUHC Agency directly confronts long-standing structural challenges in Sierra Leone’s health financing landscape. Currently, out-of-pocket payments account for a significant 56% of total health expenditure, far exceeding the sub-Saharan African average of 30%. Critically, less than 1% of Sierra Leone’s population is covered by any social health protection scheme, leaving many vulnerable to catastrophic health spending and pushing households deeper into poverty. Additionally, with 75% of health financing reliant on donor contributions, ensuring coherence with national priorities remains a pressing issue.
The draft bill is rooted in the Ministry’s Health Financing Strategy 2021–2025, which advocates for creating a Universal Health Coverage Fund, integrating with SLeSHI, and developing operational and regulatory systems to support long-term health sector sustainability.
The WHO has reaffirmed its full technical support to the Ministry in finalizing and operationalizing the SLAUHC Bill. This includes assistance with institutional design, capacity strengthening, cost-containment mechanisms, and establishing frameworks for care quality and priority-setting.
Once enacted, the SLAUHC Agency will serve as a central institution for resource mobilization, regulation of financial flows, and oversight of major health benefit programs. It’s expected to play a pivotal role in enhancing efficiency, transparency, and equity in health service delivery.
This high-level dialogue marks a pivotal moment in Sierra Leone’s health sector reform agenda. It clears the path for establishing a national health insurance scheme and reinforces the country’s commitment to achieving health for all, ensuring no one is left behind.
MK/ac/fss/abj/APA