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Published on 8 January 2020

From Christian Aid Sierra Leone

A group of community representatives in Pujehun district, Sierra Leone have taken action on the health needs of their communities by demanding they are included in district health plans.

A community representatives shows the needs of her community in a meeting with duty bearers

In Sierra Leone the availability and accessibility of health services for the most vulnerable women, children and men continue to be undermined following the devastating impacts of the 2014 Ebola crisis, coupled with high poverty rates, high illiteracy and inequitable social norms. With some of the worst health infrastructure in the world, it is shocking that women are 150 times more likely to die in childbirth here than in the UK, according to the UNFPA.

Source: UNFPA Sierra Leone, Maternal Death and Surveillance Report, 2017

To combat this, Christian Aid’s Ellis-Hadwin health legacy (HL) project aims to improve reproductive, maternal and child health. In Sierra Leone partner organisation Budget Advocacy Network (BAN) and Rehabilitation and Development Agency (RADA) are working with 22 communities to raise their voices and demand accountable actions from their duty bearers. At a recent meeting each of the communities had two representatives, of which half were women, who met with top decision makers from district council, District Health Management Team (DHMT) as well as district civil societies and the media.

Improving community involvement 

A key objective of the HL project is to increase transparency, accountability and responsiveness of the health service. Citizen’s involvement in government planning was recognised as being at a low level across all districts of the country. As part of this project, BAN, among other actors, have made some progress toward changing this. BAN now facilitate citizen’s participation in the budget process and produce simplified versions of district health budget. 2018 was the first time communities in Pujehun district participated in budget discussions both at national and district level.

With an increased awareness of the budget and planning processes coupled with meetings like this, community representatives are able to confidently present their needs. Some of which included;

  • provision of WASH facilities,
  • rehabilitation and completion of health and water infrastructure
  • refrigerators to preserve vaccines.

In Bomi community, we have started construction of our health facility through our own resource mobilisation. We now need the District Health Management Team and District Council to support its completion.

- Chief Mustaph Kemokai.

This recent meeting was an opportune time for citizens to engage health authorities from within the District Council and the District Health Management Team (DHMT) as they were working on the District Health Development Plan 2020. It was a space for them to raise their voices to demand that these needs are reflected in the district plan but also gave the opportunity to hold their duty bearers accountable to their commitments.

Creating a space like this which facilitates constructive dialogue between right holders (citizens) and duty bearers that is solutions focussed is a powerful tool. It generates immediate decisions on simple and complex situations.

Commitments to act

Communities were able to take away commitments made by officials that their priorities would be considered in implementation of the 2020 plan. An impressive outcome of the meeting were some key actions agreed between the communities and duty bearers which they believed would help to address the identified gaps, fulfil commitments and sustain actions. These were:

1) communities continue to actively engage in future budgeting and planning between July-December each year

2) communities identified health priorities to present to council and DHMT

3) communities work with councillors to keep track on development process from planning stage to disbursement and implementation stage


These actions reflect a commitment from duty bearers to uphold their promise to listen and action the needs identified by communities. They must now keep the officials accountable to the commitments made. This project will carry on for another year with a focus on ensuring a lasting and sustainable legacy of community driven advocacy that results in improved health services for the most vulnerable in these societies.

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Ellis-Hadwin Health Legacy

The Ellis-Hadwin Legacy is a £2.9 million fund set up to deliver a three-year health programme in Burundi, Sierra Leone and South Sudan.

Public finance, anti-corruption and accountability in Sierra Leone

Working to strengthen public financial management, anti-corruption and accountability institutions. Our mission is to ensure that public resources support inclusive development that benefits all the citizens of Sierra Leone.