Sierra Leone: How President Julius Maada Bio’s reforms saved the health system.
Sierra Leone’s health system, once crippled by decades of neglect, has undergone a radical transformation in five years. Under the leadership of President Julius Maada Bio and Minister of Health, Dr. Austin Demby, the sector has benefited from structural reforms that have restored citizens’ confidence and saved thousands of lives.
One of the major advances has been the overhaul of recruitment. Fueled by opaque and clientelist practices, processes have given way to a transparent digital platform, allowing thousands of health workers to be hired based on competence, not favoritism. This modernization has made it possible to increase the workforce by 15% and to put an end to the « brown envelope policy » that was plaguing the sector.
On the technical level, the country has considerably strengthened its infrastructure. Sierra Leone has grown from a single oxygen plant in Connaught to twelve operational plants across the country, ensuring a vital supply for patients in respiratory distress. The construction of additional plants, such as the one in Kerry Town, and the expansion of the oxygen network have transformed emergency care.
At the same time, the health information system has been digitized. The launch of a « Health Information Hub » and a pregnancy tracking application have enabled real-time monitoring of data, facilitating targeted interventions. It is these innovations that have contributed to the dramatic reduction in maternal mortality: the rate has fallen from 717 deaths per 100,000 live births to about 354 today, a decrease of more than 70%. The inauguration of the Kono Maternal Center of Excellence, with the country’s first rural neonatal intensive care unit, illustrates this priority given to the survival of mothers and newborns.
Finally, the government has invested in state-of-the-art equipment, such as CT scanners in Connaught and Kenema, reducing reliance on medical evacuations abroad. With the mobilization of international partners for the development of a new Strategic Plan 2026-2030, Sierra Leone continues to build a resilient and patient-center health system, in line with its ambition of universal health coverage.
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