By Foday Moriba Conteh

In a bid to boost domestic resource mobilization and strengthen transparency and accountability in immunization and primary healthcare financing in the country, Health Alert Sierra Leone, in collaboration with WASHNet, GHAI and the Government of Sierra Leone, officially launched the Advocacy to Increase Financing for Immunization and Primary Healthcare Project on Wednesday, March 19, 2025. The initiative, which will cover six districts across all five regions of Sierra Leone, aims to engage key stakeholders in addressing financial gaps in immunization and healthcare services. The launch event took place at the Freetown City Council Hall.

In his address, Victor Lansana Koroma, Executive Director of Health Alert Sierra Leone, emphasized the project's focus on expanding immunization coverage and strengthening primary healthcare across six targeted districts Bombali, Kenema, Western Area Rural, Karene and Falaba.

He added that the project will engage a broad network of stakeholders, including national and district Government officials, healthcare providers, civil society organizations (CSOs), community leaders and the media.

He informed the gathering that the advocacy project aims to drive policy change by working closely with the Finance and Budget Committees responsible for decision-making and fund allocation at the national level adding that the district level engagement will involve District Health Management Teams (DHMTs), District Budget Oversight Committees (DBOCs), local Government officials, public health workers and community health workers who play a critical role in healthcare delivery. CSOs and media outlets will also be key partners in advocacy, awareness-raising and accountability efforts.

He pointed out that the project’s core objectives include increasing domestic resource mobilization at national and sub-national levels for primary healthcare and immunization services, ensuring efficient execution of domestic funds to facilitate timely disbursement to frontline healthcare providers and guaranteeing timely payment of Gavi co-financing obligations to support immunization efforts.

He concluded by stating that mobilizing resources and ensuring sustainable healthcare financing, the project seeks to reduce preventable diseases, strengthen Sierra Leone’s immunization programs and enhance overall public health outcomes.

According to Nathaniel Soloku, Project Consultant for the Advocacy to Increase Financing for Immunization and Primary Healthcare Project  as a lower-middle-income country (LMIC) with a GDP of $854 per capita, Sierra Leone's health sector financing falls short of the Abuja Declaration’s recommended allocation of 15% of Government expenditure. While budgetary allocations to health have increased over the past five years, they remain insufficient to meet national healthcare needs, with out-of-pocket healthcare spending reaching 50.4% (NHA 2021) and heavy dependence on donor funding, he maintained.

Nathaniel Soloku emphasized that immunization is a crucial pillar of the Ministry of Health's (MOH) service delivery, with rising demand for funding in recent years. Although immunization financing in Sierra Leone has seen significant progress, driven by both domestic and international support, challenges persist, he pointed out.

He also highlighted several challenges in domestic immunization financing, including weak domestic revenue mobilization, limited fiscal space, inadequate budget allocations and a lack of innovative financing mechanisms such as public-private partnerships and health insurance schemes. He further noted that the absence of pre-financing mechanisms has made the sector overly reliant on external donors.

To address those issues, Nathaniel Soloku called for an increase in Government budget allocations for immunization and overall health system strengthening. He urged policymakers to develop stronger domestic resource mobilization strategies, such as earmarking taxes for health financing and establishing innovative financing mechanisms to reduce reliance on external donors.

Hon. Tamba S. Johnny, Chairman of the Parliamentary Health Committee, Parliament of Sierra Leone emphasized the need for domestic resource mobilization, urging the Government to allocate more funds to primary health care (PHC). He advocated for funding policy dialogues and technical assistance, including drafting legislation to support PHC.

“Increasing the Government’s budget for primary health care is essential. This should involve structured funding policy dialogues and technical assistance to create effective legislative frameworks,” he stated.

He called on the Government to explore social health insurance, community-based health insurance and public-private partnerships as ways to diversify funding sources.

Additionally, Hon. Tamba S. Johnny stressed the need for efficient resource allocation. He proposed that the Government collaborate with civil society organizations, such as Health Alert, to utilize tools like resource mapping and expenditure tracking. These measures, he noted, would ensure that funds are directed to frontline services, including Government hospitals, ambulance services, and community health centers.

On the issue of immunization, Hon.Tamba Johnny called for strengthening supply chains to ensure vaccines are available in the right quantities and stored under appropriate conditions before distribution.

In his keynote address, Dr. Desmond Maada Kanghai, Program Manager of the Expanded Program on Immunization at the Ministry of Health, emphasized the need for increased domestic financing to sustain immunization and primary healthcare initiatives, highlighting the challenges in securing adequate funding, noting that donor contributions have played a critical role but are not a long-term solution. “We cannot keep counting on donors. We must ensure that we mobilize resources within the country to respond to emerging health issues effectively,” he stated.

He noted that substantial progress has been made in reducing the number of zero-dose children those who have never received any vaccines. In 2022, there were approximately 42,000 zero-dose children in Sierra Leone; however, that number has now fallen below 10,000. Despite this progress, Dr. Desmond Maada Kanghai stressed that continuous efforts are needed to sustain and further improve immunization coverage.

Dr. Desmond Maada Kanghai also underscored the importance of timely disbursement of funds to frontline healthcare services. “Delays in fund transfers lead to vaccine shortages and essential supply stock outs, severely impacting immunization coverage, particularly in remote areas,” he explained. He urged for improved financial management to ensure that funds reach healthcare providers without unnecessary delays.

Reaffirming the Government’s commitment to achieving universal health coverage, Dr. Desmond Maada Kanghai emphasized that immunization must remain free and accessible to all citizens. He pointed out the interconnected nature of public health, noting that infectious diseases know no boundaries. “If we fail to vaccinate a segment of the population, the entire country remains at risk,” he warned.

To address those challenges, he advocated for expanded vaccine distribution in private healthcare facilities, faith-based institutions and schools, ensuring equal access across different sectors of society.

Concluding his address, Dr. Desmond Maada Kanghai reiterated the necessity of developing sustainable funding mechanisms. He urged stakeholders including the Ministry of Finance, private sector players and development partners to collaborate in creating a basket fund that guarantees consistent financial support for immunization and primary healthcare services.