An MLI Narrative: How did Sierra Leone Provide Free Health Care?

John Donnelly
Ministerial Leadership Initiative for Global Health
July 4, 2011


The first in a series of narratives on the inner workings of health ministries. In this MLI narrative, an in-depth look at the key moments behind how a war-torn nation started free care for pregnant women, breast-feeding mothers, and children under five years old.

At a dinner during the European Development Days events in Stockholm, Sweden in October 2009, Mary Robinson, the former president of Ireland, turned to the gentleman sitting next to her. He was President Ernest Bai Koroma of Sierra Leone. The gathering was full of chatter about the emerging global financial crisis and its impact on aid to countries like Sierra Leone, but Robinson, then president of Realizing Rights, had something else on her mind. Sierra Leone was one of five countries supported by a program that she helped to start called the Ministerial Leadership Initiative for Global Health (MLI), and she wanted to talk about the country’s health system.

She asked Koroma if he had set his top priority.

“Maternal health,” he said without hesitating. He then told Robinson a secret. He said he was about to set in motion a free health care plan for pregnant women, mothers who were breast-feeding, and all children under five.

“Really?” Robinson said, pleased with the unexpected news. “Are you meeting lots of resistance?”

Koroma laughed. “Oh yes, absolutely,” he said. “The entire donor community is saying this couldn’t happen. But I am the president, and this has to happen.”

  • Covering issues affecting the ministries and the people they serve.

    Leading Global Health Blog

    Even though I have worked in Sierra Leone in the past, the role of MLI Country Lead has given me the opportunity to build upon these previous experiences and to work closely with members of the Ministry of Health and Sanitation (MOHS), to support the implementation of health policies and reforms that they have prioritized.


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