Expanding Health Sector Accountability in Sierra Leone through Citizen Engagement and Stakeholder Coalition.




Sierra Leone emerged from the Ebola Pandemic of 2014-2016 with a fragile health system (despite legal and policy frameworks put in place to handle the fallout of the pandemic) which had to cater to existing vulnerable groups (People Living with HIV, for example), of which COVID-19 would add to. However, this crisis did not result in greater transparency or accountability. On the contrary, it may have created an opportunity for managers of public funds to exploit the urgent nature of the pandemic through opaque processes resulting in graft. On a positive note, through the CTAP advocacy, the Audit Service Sierra Leone (ASSL) conducted an extensive audit of the management of COVID-19 funds by the National COVID-19 Emergency Response Centre (NaCOVERC) and several other government ministries, departments, and agencies. The audit revealed serious cases of mismanagement, noncompliance, and corruption. 

BudgIT Sierra leone and other Civil Society Organizations have been contributing to campaigns demanding accountability for COVID-19 resources and increased healthcare funding. We have achieved the following milestones under the CTAP project. 

Public Education: information is power; hence, it is citizens’ fundamental right to access information without fear. Through our interventions and advocacies, Health authorities have started providing accurate and timely information to the public on diseases and the distribution of medical supplies to DHMTs and health facilities due to some part of our effort in bringing civil society and people’s participation in the health sector accountability.


Citizen’s engagement.

First and foremost, the government works for the citizens and is accountable to them. Citizens are interested in knowing their tax monies aren’t being spent frivolously. We have trained citizens on the need to always maintain contact with the members of parliament and help us get things fixed. Our engagement helped to educate them, so they know what’s going on and can speak intelligently about it. Through these conversations, citizens realise they have good ideas that can solve some of the social issues their communities currently face regarding healthcare and community well-being. 

There seems to be a direct link between knowledgeable citizens and the ability to raise fees/levies for services. The more thoughtful citizens are about the services they want, the more willing they are to help us design something that meets their needs and resources.

During these engagements, salient questions and issues were raised, which we took to the authorities for answers. People who feel connected to their governments participate in making the government better. It’s essential to think like an individual’s voice can be heard when they address bureaucracy. Citizen engagement is more than voting or volunteering. It’s up to the government to embed itself in citizens’ daily lives for both feedback and monitoring service delivery.

Many of our population have been left out of building the community’s future. Current leaders do not know how to serve these communities best and this has left serious gaps in the quality of life the citizens are living. 

Therefore our citizens’ engagement helped to reach out to those people who are marginalized and left out, as the majority of Sierra Leoneans, especially in the rural communities, do not have access to such information. We were able to connect the people so that they understand what is necessary for them and, more specifically, when it comes to covid 19 resources and where these resources came from and how they are utilized. This helped citizens to ask questions and demand social justice in their communities without fear or favour.

Citizens’ engagement brought the relationship between people and those responsible to provide the most needed services to them.  Government is the largest employer and has a mission much more significant than its resources. Only by engaging citizens can we found solutions that make sense and are achievable, given our limited resources. So people need to engage with those who provide them with services constantly.

Town hall meetings in all the provincial regions of Sierra Leone has opened the space for constructive engagement with civil society and the grassroots population on issues affecting service delivery, especially in the health sector in Sierra Leone. Before now, these issues were never discussed in the public domain have now been openly discussed and presented.

This has also contributed to openness and ensuring that those in authority are held accountable and that there is transparency and accountability in executing public duty for the benefit of the citizens whose taxpayers’ monies are used to pay for those services. These engagements has has succeeded in limiting issues of corruption in the health sector. This has also helped in the fight against covid 19. As countering misinformation on covid 19 with the participation of health workers, civil societies, youth groups, and local leadership, more people are getting vaccinated. Vaccine hesitancy has been greatly reduced through the public education campaign. 

Inclusive and Participatory Programmes: Through our campaigns, the health sector has started making its programmes more inclusive and participatory, especially for the youths in responding to issues of health and in solving the problem of transparency, accountability, corruption, and participation. 

Proper Waste Management: It is good to promote a clean and safe environment, hence the health sector needs to set up mechanisms to better engage with appropriate stakeholders and authorities to ensure that they address the issue of poor waste management in the city to avoid the threat and spread of disease in the city. The city councils are becoming robust in handling waste management in the cities.

Effective Monitoring and Supervision of Health Facilities: when the health sector is monitored regularly (from the inception to the reporting stage) of any programme or supply or distribution of medical supplies or disbursement of funds, this will help promote transparency and accountability in the health sector, as authorities will be accountable for each and everything they receive, give, and do.

Research on Health Sector Accountability (HSA)

A successful response toCOVID-19 requires not only financial and technical resources, but also the efficiency and insights that real-time data bring to the process and administration of resources. BudgIT understanding the flow of process conducted a survey on health sector accountability, The study looked at the dynamics of health sector accountability in Sierra Leone from the perspectives of policy and reforms, political economy, management, corruption, legislative oversight, procurement, accountability, finance and expenditure, and citizen participation and access.  The result of this research was widely shared with the government and relevant stakeholders who intrun took these recommendations to parliament. The specific objectives of the research include: Health sector Governance, Political Economy of the Healthcare Sector, Laws and Legislative Oversight on Healthcare, Healthcare Policy, Funding and Gaps, Citizen Data and Voices on Healthcare Access and Accountability Route to Reform.

The current findings suggest that significant progress has been made in the health sector governance space. The multi-stakeholder approach in every tier of the health administration and policy formulation has been clearly given a boost to the sector. This was largely evident in the aspect of the devolution of responsibilities and the inclusion of local government authorities in the administration of primary health care at district and ward levels.

The findings also identified that the additional budgetary support from the central government to the health sector, coupled with the inadequate Parliamentary Oversight on Health, raised the funding challenges and aided requisite policy, formulation, and development towards the sector. Additionally, the involvement of the. HRMO in the promotions, recruitments, and transfers of healthcare workers were to largely reduce the unfair advantage in the sector and enhance the overbearing human resource challenges and the undue delay in the approval of volunteer nurses. But this remains a challenge.
The survey findings revealed that irrespective of the additional budgetary allocation, policyreforms, and system reviews, the introduction of the FHC programme to improve the access and confidence of both the health care workers and the end users has not been impressive. The sensitization around this report to government and civil society organizations has open constructive discussions on how to address the challenges. This had led the ministry of health and sanitation to boost its monitoring of health care facilities right across the country and recently increased the salaries of healthcare workers in the country.

This spurred the regular monitoring of health facilities in the country over this period. 

Leveraging Open Government Partnerships: We’ve also engaged the Open Government Partnership (OGP) to include the Health Sector Accountability to the next National Action Plan (NAP) and meeting with the steering committee members was welcomed news for them. In another note, The Sierra Leone Anti Commission (ACC) are excited to see such a move by us in supporting their work. 

Gap in Communication in addressing Covid-19: There is a gap in communication with the district structures in the fight against COVID-19 as there had not been any engagement to show how accountable and transparent the structure is. Peoples experience with nurses at the Government hospital where nurses request monies for Free Health Care services. This is so prevalent in the health sector and therefore requires citizens to demand service providers to be accountable and transparent in the service they deliver to citizens. This we have closed through coalitions and media communications on three  radio stations and two TV stations with programs currently running across the country. 

Constraints in the distribution of drugs: Health centres face constraints faced in the distribution of the free health care drugs which are mostly delayed and the cause for the accusation of drugs being sold to patients. Senior health members own pharmacies and health centres where most of these drugs are directed before they reach the required final destinations.

We are encouraged to continue as a watch dog towards achieving the global standards for health in Sierra Leone.