Sierra Leone’s 2024 audit report has uncovered extensive financial, operational, and governance failures across major public hospitals in the country, raising serious concerns about patient safety, service delivery, and the management of public health resources.
At Connaught Teaching Hospital, auditors found that critical services were overstretched due to equipment failures and weak operational systems. Only three of the hospital’s four dialysis machines were functional, with the fourth remaining broken since 2023 due to the absence of a specific spare part. The aging machines could operate for only eight hours a day, severely limiting patient access and forcing some critically ill patients to defer treatment. The audit also cited a lack of regular staff training and poor waste management, including a defective incinerator used for medical waste disposal dangerously close to a kitchen area.
Maternal and child health facilities were found to be operating under alarming conditions. At Rokupa Maternity and Child Health Hospital, auditors observed that the labour ward had no running water, only one delivery kit was available to manage multiple births, and sterilisation equipment was lacking, exposing staff and patients to serious infection risks. Revenue amounting to NLe309,700 was neither recorded nor deposited into the hospital’s bank accounts, and there was no evidence showing how the funds were utilised.
At King Harman Road Maternity Hospital, faulty suction machines and sterilisers forced staff to improvise during surgical procedures, increasing the risk of uncontrolled bleeding and infection. Princess Christian Maternity Hospital continued to operate a mortuary with a completely damaged cooling system, despite repeated audit recommendations for urgent repairs, raising concerns about dignity, safety, and public health standards.
Payroll management failures were identified across several hospitals. Auditors reported that large numbers of staff at Rokupa, Princess Christian Maternity Hospital, Ola During Children’s Hospital, Makeni Regional Hospital, and Sierra Leone–China Friendship Hospital in Jui failed to present themselves for physical verification, yet continued to receive salaries totalling millions of leones. The audit warned that public funds may have been paid to non-existent staff, representing significant financial loss to the state.
At Makeni Regional Hospital, auditors found that free healthcare drugs and consumables were not supplied for most of 2024, forcing pregnant women, including those undergoing caesarean sections, to purchase essential medicines out of pocket. The hospital also lacked functioning oxygen machines, ICU monitoring equipment, essential surgical drugs, and proper storage conditions for temperature-sensitive medications.
Similar challenges were identified at Bo Government Hospital, where the oxygen plant had been faulty since April 2024, leaving maternity and paediatric patients without reliable oxygen support. The hospital also struggled with widespread equipment breakdowns across multiple departments, compromising emergency and critical care services.
Conditions at Kenema Government Hospital were described as dire. Auditors found inadequate water supply, absence of toilet facilities in key units such as triage and physiotherapy, and severe shortages of basic medical equipment. These deficiencies were flagged as serious threats to infection control, staff safety, and quality healthcare delivery.
Across all facilities reviewed, auditors repeatedly called on medical superintendents, chief medical officers, and senior officials at the Ministry of Health to take immediate corrective action, strengthen internal controls, address staffing and equipment gaps, and prioritise patient safety.
The findings point to deep, systemic weaknesses in Sierra Leone’s public healthcare system, driven by chronic underinvestment, poor oversight, and persistent accountability failures.
