Free Health Care Initiative (FHCI) in Sierra Leone

4 Briefings on this initiative which exammine gains for mothers and young children, finance implications and monitoring and evaluation


In 2010, the Government of Sierra Leone took steps towards establishing the Free Health Care Initiative (FHCI). At its core, this was the removal of user fees (on drugs and consultations) for pregnant women, lactating mothers and children under 5 years of age

There are 4 briefs on this Initiative:

Sierra Leone’s free health care initiative: financing implications

This brief is based on an independent review of FHCI completed in 2016, which looked at financing changes following the initiative’s launch, and focuses on the pre-Ebola outbreak years (2010-2013). It outlines how financing flows changed, and highlights some of the major strengths and weaknesses in resourcing the initiative.

The free health care initiative (FHCI) in Sierra Leone: real gains for mothers and young children

There was very high mortality and morbidity levels among mothers and children and reports that financial costs were a major barrier to health service uptake and use by these groups. This brief highlights that FHCI triggered some real gains in the health system such as revitalised structures for sector governance; increased staffing; and better systems for staff management and pay, and for getting funds to the facilities.

Monitoring and evaluation (M&E)in Sierra Leone’s health sector

This brief notes that a strong M&E system is crucial to help improve performance and achieve results. Several key points were identified as part of the review to strengthen health sector M&E processes.

Fiscal space analysis in Sierra Leone: the free health care initiative and universal health coverage

This brief highlights how Sierra Leone can improve the sustainability of the free health care initiative (FHCI) financing, lower household out-of-pocket (OOP) payments on health care, and decrease its dependence on donors. A secondary analysis provides insights into how Sierra Leone could work towards achieving its longer-term health goal of Universal Health Coverage (UHC).


Health and Education Advice and Resource Team. Free Health Care Initiative (FHCI) in Sierra Leone Briefs Series. Health and Education Advice and Resource Team (HEART), Oxford, UK (2016)

Published 30 June 2016