The Ministry of Health & Sanitation (MOH&S) is the government department responsible for the delivery of health care services in the public sector. The overall goal of the Ministry can be summarized as the provision of national affordable health care to enable the population of the country to attain and maintain a satisfactory level of health. This is in line with the commitment given in Section 8 3(d) of the Constitution of Sierra Leone 1991 that “there are adequate medical and health facilities for all persons, having due regard to the resources of the State”. 6.2 A strategic objective of the Ministry for a number of years has been the decentralization of health services in order to provide basic primary health care at district level supported by a network of secondary and tertiary services. This policy has suffered major setbacks in recent years as a result of the civil war. Many of the country’s health care delivery services were devastated during the conflict and over 60% of the facilities, through which community based services were delivered to the population, were either completely destroyed or damaged. As a result, it has been estimated that overall access to basic health care services for the majority of Sierra Leoneans declined from 40% in 1991 to 20% by 1998. This deterioration in the health status of the majority of the population in Sierra Leone has subsequently been reflected in reduced life expectancy as well as other mortality and morbidity indicators for the country, which are some of the worst in the world. 6.3 The delivery of existing hospital services is provided by a network of establishments, ie Government, Ministry of Defence and Education, Mission, Industrial (often a mines facility), NGOs and private health care. Government hospitals are located in Freetown and the larger population centres of the country. Health care services at district level are currently provided by peripheral health units (PHUs) overseen by the District Health Management Team headed by the District Medical Officer who is responsible for managing public health activities in the district. PHUs are the delivery points of Primary Health Care in the community and some Districts may have up to 50 or more of these units. The National Health Action Plan specifies that individual units should provide for a Community Health Centre (CHC), a Community Health Post (CHP) and a Maternal and Child Health Post (MCH) in every Chiefdom. PHUs are in place in the Western Area and all 12 Districts in the country. The day to day running of district hospitals, which are government referral hospitals at district level, is supervised by Medical Superintendents assisted by a Matron and Hospital Secretary. It is eventually intended, when the necessary legislation is enacted, that Hospital Management Committees will be responsible for running individual hospitals and a start has already been made in introducing these bodies.

Information provided by the Planning and Information Directorate at the Ministry indicated that there are currently 32 functioning hospitals in Sierra Leone supported by a network of 417 functioning PHUs. Appendix D records the distribution of these facilities by type and category. 6.5 The Ministry’s headquarters in Freetown contains the Office of the Minister and those of the Directors General Medical Services and Management Services together with their professional and administrative staff. In addition to supporting the Minister, the headquarters’ staff are responsible for policy, planning and coordination activities, management and oversight of specific health programmes as well as supporting and monitoring the work of the districts and other health sector areas. Liaison and collaboration with donors, international agencies and non-governmental organizations (NGOs) are also important activities at this level of administration. According to figures provided by the Ministry, it had 5239 employees on its Staff List at the time of the study. Of this figure, there were 225 staff in post at the Ministry’s headquarters consisting of a mix of permanent and temporary employees. The Ministry’s budget for 2002, covering personnel expenditure and other charges, is Le 44.3 billion and the projected figures for 2003 and 2004 are Le 48.7 billion and Le 53.1 billion respectively. 6.6 In addition to the health care services provided by the Ministry of Health and Sanitation, there are numerous other stakeholders in the health sector. These include local and international NGOs providing a range of services, UN Agencies and other international institutions that fund various programmes, projects and activities. In this context, the World Bank has been actively supporting the Ministry with a $20m programme in connection with the Integrated Health Sector Investment Project (IHSIP) that should end this year. This programme was originally designed to provide funding for the rehabilitation of health centres and health care services in rural areas but the escalation of the civil war in rural areas subsequently shifted IHSIP emphasis away from rural development to the provision of war related emergency services. 6.7 The World Bank is shortly to commence a further $20m project, the Health Sector Reconstruction and Development Project (HSRDP) that is scheduled to run from 2003-2007. This will concentrate on four districts and is primarily concerned with reconstruction, rehabilitation and re-equipping health service facilities in these areas as well as providing institutional support. The African Development Bank (ADB) is also currently active in providing support in the health sector in Sierra Leone under the Health Services Rehabilitation Project (HSRP). The objective of this project is to strengthen the quality of health care delivery systems through the rehabilitation of health facilities, improvement in the management of health services and assistance with the national essential drugs programme.