Transforming Sierra Leone’s Healthcare

A Vision for Safe and Affordable Surgery

By Dr. Austin Demby, Minister of Health and Sanitation for the Government of Sierra Leone

As experts from the surgical and healthcare world gather for the 64th Annual Conference and Scientific Meeting of the West African College of Surgeons in Sierra Leone this week, a profound dedication to advancing surgical knowledge and practice in the region is palpable. At the forefront of discussions lies the conference’s pivotal theme: access to safe and affordable surgical and anesthetic care in West Africa. This theme highlights the pressing need to address disparities in healthcare capabilities and capacities across the region, especially the critical importance of equitable access to quality surgical interventions.

The spectrum of surgical needs in Sierra Leone is broad, encompassing basic obstetric procedures, trauma surgeries, orthopedic surgeries, and more. The demand for surgical services is high, and timely access to interventions is often critical. Currently, our surgical capability at the surgeon’s level is limited, with only 15 residents, six general surgeons, two orthopedic surgeons, and two urology surgeons serving a population of eight million people.

Access to safe surgical care is a fundamental necessity. We firmly believe that every individual has the inherent right to live. Life matters, and we are unwavering in our dedication to upholding that principle through the provision of quality surgical care.

As the Minister of Health for Sierra Leone, I am dedicated to realizing the President’s vision of investing in people and human capital development. I see my role as focusing on the health aspect as we build our nation, ensuring that our people are healthy and able to achieve their fullest potential as individuals, family members, community and district members, citizens, and contributors to the continent’s prosperity.

Sierra Leone’s healthcare transformation is a multi-faceted journey that demands collective effort, innovation, and unwavering determination. We are laying the groundwork for a comprehensive healthcare system that meets the diverse needs of our population. The challenges are significant, but with determination, collaboration, and a shared vision, we believe in the transformative power of healthcare to uplift our nation and its people.

Safe Surgery and Surgical Education: The Cornerstones of Healthcare

Accelerating access to safe and affordable surgical and anesthesia care in West Africa is critical. The current landscape reveals a disparity in healthcare capabilities and capacities across the region. By fostering collaboration and networking among countries, we can leverage collective strengths and resources to address these gaps more efficiently.

Addressing the critical shortfall of surgeons in our own country is paramount, and our strategy involves tackling it from multiple angles. Our approach includes addressing the supply side by increasing the number of surgeons and subspecialties in surgery across the country. We also hope to dramatically increase the number of residents we currently have. Recently, we opened several new residency programs and established three new postgraduate schools.


Additionally, we acknowledge that top surgeons aren’t available in every village or community. Therefore, we are looking at ways to supplement the capabilities of community health officers and community offices by providing them with basic surgical training. This training enables them to perform minor surgeries even in remote parts of the country.

In our ongoing efforts to navigate the intricate healthcare landscape of Sierra Leone, my focus has gravitated toward the paramount importance of safe surgery and the urgent need for comprehensive surgical education. I wake up every morning determined to change healthcare delivery in this country. I am pleased to be surrounded by people who share the same determination.

I often tell others that I am angry at times. But I feel that anger can be a valuable indicator of what is unacceptable. It is unacceptable to have a preventable death in our country. It is unacceptable, with all the tools that we have, to have an HIV infection in this country for example. It is unacceptable for somebody to die from AIDS when we have all the tools available to us.

I think it’s important to feel anger towards these issues because it drives action. When you’re angry, you’re compelled to do something about it. It’s not just another baby who died; each one is an individual with the right to live.

What we’re doing now is collaborating with our healthcare workforce throughout the country to instill this mindset that everybody’s life matters.

When somebody walks into a hospital or clinic, there’s a reason why they don’t go to the traditional healer. They go to the hospital with the confidence that they will get the care that they need, and that they will find compassionate people there who care about their health. I’m working with my team to ensure that people feel assured in seeking our assistance.

By energizing the populace and fostering strong relationships with service providers and the people they serve, we have the recipe for making dramatic changes in Sierra Leone. We don’t compare ourselves with any other nation; we’re competing with ourselves. We set bold and seemingly impossible targets, and we work towards achieving them. It’s exciting and a real opportunity to make a difference in people’s lives.

Education, Health, and Food Security: The Triad for National Development

Our country, like many others, grapples with a host of challenges, but our unwavering commitment lies in addressing these issues, particularly in the realms of education, health, and food security, serving as fundamental pillars driving national development forward.

Sierra Leone’s journey towards a healthier and more prosperous future begins with education. Our healthcare priorities are investing in education to ensure knowledge acquisition and the development of individuals to their full potential.

Coupled with education is the imperative for a healthy population. An educated, healthy populace is better equipped to contribute to national development, breaking the cycle of poverty and fostering a robust society.

Food security is the third element of our triad, recognizing that a well-nourished population is better positioned to thrive, both physically and mentally.

Collaboration with Organizations for Sustainable Solutions

Our collaboration with organizations like Mercy Ships is instrumental in delivering surgical services and investing in training local healthcare professionals. Their unwavering dedication to service, driven by the spirit of teamwork, care, and hope, is truly commendable. Their service delivery provides people with hope, tackling challenges that are difficult to comprehend.


The investment in training counterparts from nurses and anesthesiologists to technicians and counselors — to just see how this is done with tender loving care for patients is incredible. Our residents are lining up to go and provide services and training on the ships. Additionally, we are thrilled about the prospect of dental care training and the establishment of a dental school in our country. These initiatives signify a significant step towards building a self-sufficient healthcare system that can thrive long after Mercy Ships’ departure.

Additionally, the current gathering of the West African College of Surgeons to Sierra Leone in Freetown is a huge milestone, providing an opportunity to showcase our progress and foster collaboration among West African nations. We’re expecting over 700 surgeons from throughout the continent and beyond. They are here to have very candid deliberations on the state of surgeries in Africa and what the future holds for the continent, and where we should be driving our focus.

The Vision for Sierra Leone’s Healthcare Future

Looking ahead, the vision for Sierra Leone’s healthcare future falls into four domains. The first is primary healthcare, emphasizing the importance of taking healthcare as close to the people as possible. Currently, 85% of the population has a health facility within a five-kilometer radius of wherever they are. That’s incredible in terms of access.


What’s exciting is witnessing the tangible impact of these efforts. We’re observing significant drops in maternal mortality rates, improvement in immunization rates, and the introduction of new vaccines and practices. Recently, we launched a new malaria vaccine, and just the other day, we introduced a new HPV vaccine as part of our determination to eliminate cervical cancer in the country.

The second domain involves staffing, with a focus on increasing the number of skilled healthcare professionals, including surgeons. We aim to enhance competencies, distribution, and retention, ensuring a well-balanced and competent healthcare workforce.

The third domain centers on quality, addressing the need for reliable equipment, preventive maintenance capabilities, and the availability of drugs.

The fourth domain is health security, recognizing the importance of preparedness, rapid response, and containment in the face of health emergencies, such as a pandemic outbreak. We have launched a national Public Health Agency to ensure a coordinated emergency response. We have epidemiologists embedded in routine programs at the frontline, closely monitoring data from various health initiatives to detect any unusual activity early on.

In moving forward, we are resolute in our commitment to address many of the challenges head-on, confident that through unity and resilience, we can surmount any obstacle. With a focus on essential needs and sustainable development, we are poised to create a better tomorrow for our nation.