“Hospital Runs On Improvisation & Hope..” Frustrated Doctor Reveals

Freetown, 2025 –

Sierra Leone’s healthcare crisis is no longer a matter of speculation. It is documented, quantified, and condemned in three major reports released over the past year: the 2024 Public Health Systems Audit, the Medical Supplies and Procurement Tracking Review (2022–2024), and the National Hospital Performance Assessment Report. Together, they expose a sector where mismanagement, missing equipment, and collapsing service delivery have pushed public hospitals to the brink of structural failure.

 

According to the 2024 Public Health Systems Audit, billions of Leones were allocated between 2022 and 2024 for critical upgrades, yet essential equipment listed as “delivered” never reached the hospitals meant to receive them. Items such as oxygen concentrators, ECG monitors, sterilisation units, and portable ultrasound machines appear in procurement documents, but auditors could not verify their arrival in Connaught Hospital, Bo Government Hospital, or Kenema Government Hospital. Some supplies were later discovered in private clinics operating without full authorisation, raising suspicions of theft and diversion.

 

The Medical Supplies and Procurement Tracking Review (2022–2024) reveals an equally alarming pattern. The report found eight missing consignments of medical goods that government officially declared as “received and distributed.” Field inspections showed that district hospitals in Tonkolili, Kailahun, Koinadugu, and Karene had no record of the items. Procurement officers could not produce delivery forms, and supply-chain trackers uncovered unexplained discrepancies between warehouse inventory and distribution sheets. The review bluntly concludes that “systemic leakage” has undermined the country’s medical supply pipeline.

 

Every day, the consequences unfold at the patient level. At Connaught Hospital, the National Hospital Performance Assessment Report documented broken patient beds, malfunctioning monitors, shortages of gloves and syringes, and an emergency ward operating at twice its capacity. Doctors interviewed admitted that they routinely turn away cases they could handle if equipment were available. One surgeon told investigators that “the hospital is now running on improvisation, hope, and personal sacrifice, not on government support.”

 

In Bo and Kenema, paediatric wards remain overcrowded, and drug shortages have become normal. The auditors found that basic medicines: paracetamol, antimalarials, oral rehydration salts, IV fluids, and antibiotics were frequently out of stock, forcing patients to buy them from private pharmacies at inflated prices. The Free Health Care Initiative, designed to protect pregnant women and young children, has been “reduced to paperwork,” according to the audit team.

 

Ambulance services are captured as one of the most dysfunctional components of the system. The 2024 audit found that several ambulances government announced between 2021 and 2023 were never registered in the national fleet. Some vehicles were “missing without trace,” while others sat idle due to lack of fuel or maintenance. Communities in Bonthe, Pujehun, Kambia, and Kono continue to transport critical patients on motorbikes and improvised tricycles. The report states that ambulance failures alone have contributed to “avoidable deaths at a scale that is underreported.”

 

Financial mismanagement runs through every chapter of the reports. Millions of Leones earmarked for rural clinic rehabilitation and community health posts were redirected to administrative expenses that auditors could not trace. Clinics in Mapaki, Bendu, Yifin, and Gbonkolenken still operate in dilapidated buildings with leaking ceilings, unlit delivery rooms, and near-empty drug stores. The audits note that some facilities have not received functional solar power since their initial installation in 2018.

 

Understaffing remains another critical failure point. The National Hospital Performance Assessment Report found that more than 300 trained health workers exited the public system between 2020 and 2024 due to poor salaries, delayed allowances, and better opportunities abroad. This chronic shortage has extended waiting times, reduced surgeries, and left some district hospitals with only one doctor covering multiple departments.

 

For ordinary citizens, these failures translate into catastrophic expenses. Patients spend millions of Leones on treatment that should be free. Families sell land, motorbikes, and household items to pay for drugs. Many now arrive at hospitals only when illness becomes life-threatening, knowing that early treatment offers no guarantee of support.

 

The combined findings of the three reports issue a stark warning: unless government strengthens procurement tracking, restores accountability, increases hospital funding, and enforces transparency in supply chains, Sierra Leone’s health sector will remain in permanent crisis. The reports do not frame the crisis as future risk, it is a present reality, unfolding daily inside emergency rooms, maternity wards, and rural clinics across the country.