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Sierra Leone continues to face some of the highest rates of maternal, newborn, and child mortality globally due to a mix of communicable and non-communicable causes. The root causes of these poor health outcomes are deeply entrenched in Sierra Leone’s socio-economic and political context, which adversely impacts the health system.
Under the leadership of His Excellency President Julius Maada Bio and with strong support from the Ministry of Health (MoH), Sierra Leone has made maternal and child health a priority and has declared maternal and child mortality a national emergency.
The Clinton Health Access Initiative (CHAI) coordinated the development of a Collaborative Advocacy Action Plan (CAAP) in Sierra Leone under the CAAP initiative facilitated by PMNCH, currently undertaken in 10 countries in Africa. The CAAP initiative aims to support Sierra Leone’s health sector by explicitly facilitating coordination, driving evidence-based prioritization, reinforcing alignment with national policies, and leveraging accountability mechanisms.
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| Participants at the CAAP validation workshop in March 2025 |
CAAP Development Process: Aligning Efforts and Bringing Everyone on Board
The CAAP process has been executed under the leadership of the MoH, linking to the existing RMNCAH+N multistakeholder platform (MSP) —the central coordination mechanism in Sierra Leone’s health sector—to ensure strong country ownership and alignment with national policy priorities and processes for sustainability.
At first, a comprehensive partner-led scoping and assessment of existing national WCAH commitments was undertaken across maternal, newborn, and child health (MNCH), sexual and reproductive health and rights (SRHR), and adolescent health and well-being (AWB) issues. The aim of this exercise was to bring together all commitments in one document and to evaluate the relevance, quality, implementation status, and gaps across these commitments.
Key inputs were gathered by consulting stakeholders, including government entities, development partners, civil society organizations, and youth representatives, with thanks also to Youth Partnership for Peace and Development (YPPD), a youth-led organization, which supported the interviews and data collection processes. Discussions on findings and agreements on advocacy priorities were anchored in the RMNCAH+N MSP for deliberating on findings and defining advocacy priorities. When assessing the inclusivity of the MSP, it was noted that some key groups had not been included, such as youth-led groups and healthcare professionals. This has been considered, inviting them to deliberations, and revisions to the Terms of Reference of the MSP are under development.
“The CAAP process is a prioritization, alignment, and accountability platform for Sierra Leone’s health sector.”
- Dr. Frank Chikhata, Associate Program Director, CHAI Sierra Leone
Scoping and Assessment of Commitments: Improved Evidence for Decisions
The Government of Sierra Leone (GoSL) has made over 90 commitments to advance MNCH, SRHR, and AWB issues. These commitments span global initiatives such as the Sustainable Development Goals, ICPD@30 and FP2030, regional frameworks like the Maputo Protocol and Agenda 2063, and national plans including the National Health Sector Strategic Plan. These commitments have been brought together in a Commitment Scoping and Assessment Report.
The MNCH domain has the highest number of commitments, many of which target reducing maternal, neonatal, and child mortality. While progress has been made in this regard, gaps remain in areas such as health workforce training, integration of MNCH services into Universal Health Coverage (UHC), and prevention of mother-to-child transmission of HIV and syphilis.
In the SRHR domain, commitments aim to strengthen the legal and policy framework to support reproductive health services, including efforts to expand access to family planning, address sexual and gender-based violence (SGBV), and ensure gender equity. While the availability of family planning has improved, cultural and systemic barriers persist, and the modern contraceptive prevalence rate remains low. Efforts to secure sustainable financing and improve supply chains for contraceptives are underway, though commitments on safe abortion remain limited and largely framed within broader global agreements.
The AWB domain is the least prioritized, with fewer commitments and limited financial investment. Focus areas include mental health, school-based services, adolescent nutrition, and educational access. While there has been marginal progress in establishing adolescent-friendly services such as the implementation of mental health services in some health facilities implementation remains uneven due to weak coordination, limited accountability mechanisms, and insufficient resources.
Overall, Sierra Leone has made substantial WCAH commitments, and there is a need to strengthen implementation, monitoring, and accountability—especially for adolescent health.
The following priorities have been identified from the scoping and assessment report:
Strengthen policy frameworks for WCAH;
Increase resource allocation for implementation across all domains;
Enhance stakeholder engagement and strengthen accountability mechanisms;
Improve data collection and monitoring systems; and
Prioritize adolescent wellbeing.
This evidence-based approach helps prioritize advocacy action. It gives visibility to commitments made, generates data that can be used by the MoH to monitor health sector progress, and aims to enable national actors to concentrate limited resources and political capital on areas with the highest potential for impact.
“The built-in accountability mechanisms are essential tools that enable partners to hold the government accountable to its stated commitments“
- Dr Francis Moses, Director, Reproductive and Child Health Directorate, Ministry of Health
CAAP Advocacy Goals and Activities: Prioritized Plan for Joint Action
Consequently, the CAAP plan agreed to by stakeholders outlines five advocacy goals to guide joint efforts over the next 2-3 years
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As a result of these advocacy efforts, it is envisaged that over the next twenty four to thirty six months:
MNCH-specific budget line items will be included in the annual national health budget together, resulting in a 20% increase in MNCH budget allocation, with quarterly expenditure tracking reports published and reviewed for a fully operational budget tracking system as indicators to measure targets on budget allocation and spending;
Policy reforms, increased financing, and public awareness will contribute towards the passage of the safe motherhood and reproductive health bill, expand health insurance coverage for SRHR, reduce stigma and misinformation and result in a 15% increase in SRH budget allocation and integrating SRH services into at least 80% of primary healthcare facilities;
Adolescent-specific interventions will be prioritized, such as mental health integration in schools and expanding the FHCI to include adolescent-focused services, thereby reducing adolescent fertility rate by at least 15% and supporting adolescent mental wellbeing;
Legal frameworks will be strengthened, public awareness will increase, and survivor-centered services will be provided to protect women and girls from violence and exploitation, reaching at least 60% of communities and ensuring that at least 70% of healthcare and social service facilities provide survivor-centered support; and
Domestic health budget allocations will increase by 20% and at least three strategic donor partnerships will be developed to ensure long-term, predictable funding for WCAH issues.
By mapping stakeholders’ roles and linking them to specific goals and activities the CAAP aims to reduce fragmentation, encourage synergy, and enhance joint ownership. Progress against these goals will be monitored by leveraging key health sector accountability mechanisms such as sectoral reviews, meetings including those of the MSP and tools such as score cards.
The CAAP plan was validated in March 2025 in a workshop attended by 55 participants including District Medical Officers (DMOs), Medical Superintendents, Matrons, District Health Sisters and other health partners within the reproductive and child health space across the country.
In Service of Sierra Leone’s Health Sector
Sierra Leone’s CAAP development journey offers powerful lessons to build strong, inclusive, and partner-led advocacy and accountability systems. The process demonstrated that:
Leadership matters: When governments leads, partners align.
Participation drives legitimacy: Co-creation builds buy-in and ownership.
Plan is only the start: Ongoing coordination and accountability for agreed goals are key to ameliorate conditions for the most vulnerable and marginalized women, children and adolescents.
Evidence and transparency drives prioritization and incentivize coordination: When data and information is made easily available it reduces the barriers to coordinate, and incentivizes partners to do so
Next Steps
The CAAP implementation relies on partners, and we invite you to join efforts to achieve advocacy goals by collaborating on the listed and additional activities in the Plan!
Share your interest in joining the CAAP initiative with pmnch@who.org and join the Sierra Leone Country Digital Advocacy Hub!