Proposed Budget 2024: BudgIT Demands Immediate Reform in Sierra Leone’s Health Sector and Critiques Government Spending of NLe 29.5 Million on Overseas Medical Expenses.


Proposed Budget 2024: BudgIT Demands Immediate Reform in Sierra Leone’s Health Sector and Critiques Government Spending of NLe 29.5 Million on Overseas Medical Expenses.

November 7, 2023, Freetown-Sierra Leone

BudgIT Sierra Leone, a leading public organization raising active citizen participation in nation-building and government-citizen communication for good governance and accountability, has urged the Ministry of Health to make urgent reforms to improve health outcomes for citizens and enhance economic development.

The BudgIT Sierra Leone team attended the FY2024 Policy Hearing and Bilateral Budget Discussions, engaging with Ministries, Departments, Agencies (MDAs), and key stakeholders at the Ministry of Finance. The discussions, marked by time constraints, underscored the urgency of addressing critical issues affecting Sierra Leone’s health system. The Ministry of Health’s (MOH) budget presentation showcased notable achievements in 2022 and 2023, such as legislative enactments and infrastructure developments. However, there are more glaring challenges facing the health sector that demand immediate attention, including:

  1. Inadequate Budgetary Allocation: The Sierra Leone health sector was allocated NLe896.7 million ($39.5 million) in 2022 and NLe 938.7 million ($41.3) in 2023, representing 7% and 6% of the national budgets, respectively. This persistent gap has a substantial impact on the citizens, leaving more than half of them without access to essential healthcare services, contributing to high rates of preventable disease and mortality.
  2. High Spending on Overseas Medical Treatments: At the hearing, it was revealed that the government budgeted NLe 2 million ($89,286) for medical expenses abroad and spent NLe 29.5 million ($1.3m), a 13.75% increment from the allocated sum and the costliest expenditure in the budget. The government must focus on investments that benefit the entire population rather than making allocations for a few. To prioritize yourself over your people is illegal and inhumane.
  3. Late Disbursement of Funds: Delays in fund disbursement impede expeditious project execution and impact the overall budget for service delivery. Commonly, budget allocations are released a quarter after the intended date; this negatively impacts service delivery and leads to preventable deaths.
  4. Inadequate Medical Equipment: The contiguous budget gap has led to a shortage of crucial medical equipment, compromising healthcare quality and accessibility in Sierra Leone. Many medical facilities lack basic amenities such as ventilators, dialysis machines, ultrasound machines, and X-ray machines, which makes it difficult to diagnose and treat diseases.
  5. Shortage of Specialized Medical Personnel: The lack of specialized doctors poses a significant barrier to addressing complex health conditions. There are 1,190 health facilities and less than 200 physicians serving 7 million people. This shortage of healthcare personnel results in high wait times and impedes services.
  6. Volunteers Not on the Government Payroll: Uncompensated volunteers strain the system and must be integrated into the payroll to be sustainable. To reduce bribes and the burdens imposed on citizens, the government must invest in the healthcare sector and ensure that all healthcare workers receive appropriate compensation.
  7. Weak Infrastructure: Inadequate infrastructure undermines effective service delivery, necessitating immediate investments. All major referral hospitals need urgent refurbishment and construction/extension to create new departments that are not in existence, like ophthalmology, dentistry, ear, nose, and throat centers, dialysis centers, procurement of mortuary equipment, provision of electricity, and installation of internet facilities.
  8. Inadequate Digital Revenue Collection Methods: Sierra Leone loses revenues due to outdated revenue collection methods, which contribute to inefficiencies and corruption, highlighting the need for updated digital technologies.

“These challenges align with BudgIT Sierra Leone’s Health Sector Accountability Study findings in 2022, highlighting systemic issues deeply embedded in the health system,” said Brima Sesay, Institutional and Stakeholder Manager at BudgIT Sierra Leone.  “Of particular concern is the staggering overspending on overseas medical travel, amounting to NLE 29.5m ($1.3m), raising questions about accountability and potential misuse of public funds.”

BudgIT Sierra Leone calls attention to the 2001 Abuja Declaration, emphasizing the government’s failure to allocate at least 15% of the national budget to healthcare, as pledged. The persistent underfunding, evident in a five-year trend analysis, demands immediate corrective action to address the gravely insufficient funds allocated to the health sector.

Equally alarming is the abysmally low internally generated revenue of major government health facilities, indicating a need for enhanced transparency and accountability in revenue collection. BudgIT Sierra Leone encourages the Ministry of Health and the government to swiftly deploy digital tools to mitigate corruption and improve revenue collection in the hospital system.

To this end, BudgIT urges the government to proactively resolve these challenges and increase the sector’s allocation for substantial improvements in Sierra Leone’s health system and service delivery.


Name: Brima Sesay

Institutional and Stakeholder Manager

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