Healthcare System in Sierra Leone: Available Care, Emergencies, Medicines and Vaccinations

The Sierra Leonean healthcare system is under the responsibility of the Ministry of Health and Sanitation, which says it ensures the quality of care in public establishments, employs professional medical staff and has a national emergency medical service (NEMS) in charge of ambulances and emergency response. France Diplomatie, for its part, notes that health infrastructure is little developed, that there is no emergency service in the country and that no ambulance service or national emergency number is mentioned: in practice, the availability of rescue services should be checked on the spot, especially outside the capital.

WHO indicators help gauge the effort: about 36 dollars of health spending per inhabitant, or less than 5% of GDP, and under-five mortality of about 74 per 1,000 live births. The WHO office in Freetown follows public health programmes. These benchmarks explain why medical evacuation is the reference solution for serious situations.

For a French resident, the usual pathway combines a first-contact doctor in Freetown (practice or clinic), routine tests in the capital’s private facilities, and an evacuation abroad when local technical facilities are not enough. Details of financial cover are on the healthcare reimbursement page.

France Diplomatie lists three establishments in Freetown, all private, that can provide some emergency care: a medical centre in the Brookfields district, a hospital in Hill Station and a medical centre in the Cole Farm area, with the telephone numbers given on the health page. This list is no guarantee of permanent availability of intensive care or an operating theatre: check capacities before you need them and keep your assistance provider’s contact details.

No national emergency number is mentioned by France Diplomatie. For French nationals, the French embassy in Conakry, competent for Sierra Leone, can be reached on +33 1 70 98 93 39, with an emergency line during office hours on +224 621 00 00 10 and outside hours on +224 621 08 89 15. The Freetown diplomatic office is located at 2 Mandalay Street, Cold Storage, Kingtom.

Without an assistance contract, the embassy does not cover medical, hospitalisation or repatriation costs: France Diplomatie asks you to take out repatriation insurance before departure. See assistance and repatriation.

The official sources consulted describe no compulsory health insurance scheme accessible to a foreign resident in Sierra Leone: the NASSIT, the social security institution, pays old-age, invalidity and survivors’ pensions, but its pages read mention no health benefits. No bilateral agreement coordinates the French and Sierra Leonean schemes either.

Health protection therefore rests on the French scheme maintained (secondment outside a treaty), the CFE (the Caisse des Français de l’Étranger, the French expatriate social security fund) or international health insurance. Compare contracts on the ceiling, the coverage zone, evacuation and direct payment (expat health insurance); Expavy helps you weigh these options against your status.

France Diplomatie recommends bringing only strictly necessary medicines, in their original packaging with labels, accompanied by a prescription giving the names as international nonproprietary names (INN), which may be required on entry. Check that each medicine is authorised in Sierra Leone, plan a sufficient stock for the whole stay and never take medicines bought in the street, because of the risk of counterfeits. Antimalarials are available in Freetown.

Ebola: the WHO declared Sierra Leone free of transmission since 17 March 2016, but France Diplomatie recalls that a resurgence is not ruled out. Lassa fever is present in the east of the country. Mosquito-borne diseases (chikungunya, dengue, yellow fever, malaria, Zika) require rigorous mosquito protection; yellow fever is endemic. Also cited are cholera, typhoid fever, hepatitis A, mpox, polio, rabies and tuberculosis.

Prevention relies on repellents, covering clothing, treated mosquito nets, bottled or treated water and hand and food hygiene. Consult a doctor or an international vaccination centre before departure, and register on Fil d’Ariane (the French foreign ministry’s traveller registration service) to receive alerts.

The French vaccination schedule must be up to date for adults and children alike: diphtheria, tetanus, polio, whooping cough and measles. Yellow fever, which is endemic, is a condition of entry into the territory: vaccination is done at an approved centre, preferably at least ten days before departure. Depending on the length and conditions of the stay, France Diplomatie also recommends hepatitis A, typhoid fever, hepatitis B for frequent or prolonged stays, tuberculosis for children under 15, rabies (young children, rural stays), chikungunya and dengue in case of an epidemic or a prolonged stay, and mpox in case of risky exposure.

• Routine care: consult in Freetown, and keep the paid invoices and medical reports, which are essential for any reimbursement (insurer, CFE or the fund of a seconded employee).
• Emergency or worsening: first call the assistance platform of your contract, which coordinates transport to one of the establishments able to receive the emergency or evacuation abroad; without a contract, costs fall on the family.
• Fever: in Sierra Leone as in the weeks following your return, a fever calls for a quick consultation, as malaria and other mosquito-borne diseases can progress fast.
• Risky exposure (bite, contact with a sick person, doubtful water or food): consult without delay and mention your stay in the country.
• Consular steps: in case of serious difficulty, contact the emergency line of the Conakry embassy (+224 621 00 00 10 during office hours, +224 621 08 89 15 outside hours).

Before leaving, declare your medical history to the insurer (medical questionnaire), check that evacuation from Freetown is covered, and put together a file with INN prescriptions, blood group, vaccination booklet and the assistance provider’s contact details. For a stay of more than six months, register on the register of French nationals living abroad.