Promises and Pitfalls of the Free Health Care Initiative in Sierra Leone: An Early Analysis



The purpose of this chapter is to examine one of the most significant pieces of legislature passed by the Sierra Leone state to address one cornponent of human security—access to health care for the most vulnerable of populations, women and children. Passed in 2010, the law provides free health care for pregnant women, lactating mothers, and children under five. In light of the appalling figures concerning maternal and child mortality in Sierra Leone, the policy is an admirable one, with enormous potential to improve on these rates and change the lives of women and children in Sierra Leone. However, given the weakness that continues to plague the state and the largely externally driven nature of the intervention, with donors providing the bulk of the funding, to what extent has this policy transformed the health landscape in Sierra Leone in addressing the problem of maternal and child mortality? Based on fieldwork conducted just three months after the policy was implemented in August 2010, we provide an early assessment of the free health care initiative (FHCI), looking at its impact on the lives of women and children and participant satisfaction with implemented activities, compare the assessment with current findings, and offer policy suggestions for improved implementation. While it would seem like the more favorable international climate afforded by the post-Washington Consensus has enabled Sierra Leone to spend more in public service delivery, the fact that much of this intervention is driven from the outside has had implications on the delivery of the service as well as how it has been received.


Health Care Facility Health Care Worker Maternal Mortality Human Security Oral Rehydration Salt 
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© Fredline A. O. M’Cormack-Hale and Fredanna M’Cormack McGough 2016

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