By Millicent Senava Mannah
In Sierra Leone’s rural districts, access to healthcare remains a matter of survival. Despite recent progress in reducing maternal and child deaths, communities far from urban centers continue to struggle with limited health facilities, scarce medical staff, and poor road conditions that often cut them off from lifesaving services.
According to the Ministry of Health and Sanitation, Sierra Leone’s maternal mortality ratio dropped from 1,682 deaths per 100,000 live births in 2000 to 354 in 2023, one of the most significant declines in West Africa. Yet, nearly 79% of maternal deaths still occur in health facilities, pointing to serious quality-of-care issues.
For families in Koinadugu, Falaba, and Kailahun districts, reaching care is an uphill battle. Many residents walk several kilometers, sometimes up to three hours, to reach the nearest Primary Health Unit (PHU). During the rainy season, entire villages are cut off by flooded rivers and washed-out roads, delaying critical referrals for expectant mothers and emergency patients.
“I had to carry my wife on a hammock for hours because no vehicle could pass,” recalls Ibrahim Kamara, a farmer from Falaba District. “By the time we arrived at Kabala hospital, her condition had worsened.” His story echoes the plight of many rural families for whom distance and infrastructure often mean the difference between life and death.
The shortage of trained medical staff adds another layer of difficulty. Sierra Leone has only 0.4 doctors per 10,000 people, or roughly one doctor for every 25,000 citizens, far below the WHO’s recommended ratio of 1 per 1,000. Most physicians are concentrated in Freetown, leaving rural facilities staffed mainly by nurses, midwives, or community health workers.
Encouragingly, the number of trained midwives has risen to nearly 1,800 nationwide in 2024, compared to fewer than 100 in 2010, thanks to UNFPA and government investments in midwifery training. In addition, non-physician surgical providers now perform more than half of all surgeries in government hospitals, including 60% of cesarean sections, expanding access to emergency care in hard-to-reach districts.
The government’s Free Health Care Initiative (FHCI), which provides essential services to pregnant women, lactating mothers, and children under five, has boosted service use. Institutional deliveries rose from 61% in 2013 to more than 90% by 2017. However, frequent drug shortages, staff absenteeism, and weak supervision undermine its full impact in rural areas.
Health experts argue that tackling Sierra Leone’s rural healthcare crisis requires more than expanding facilities. “We must focus on rural retention of health workers, reliable ambulance services, and improving the quality of care delivered,” says Dr. James Kargbo, a public health specialist.
As Sierra Leone pushes toward Universal Health Coverage by 2030, bridging the rural–urban divide remains urgent. Without targeted investments in infrastructure, staffing, and quality standards, the country risks leaving its most vulnerable communities behind, families who cannot afford for healthcare to remain out of reach.
