Introduction

The World Health Organization (WHO 2020) characterizes health equity as the absence of unfair and avoidable or remediable differences in health status among groups of people. This can be achieved when those with lower socioeconomic status do not face financial barriers or other obstructions such as language, culture, stigma, distance, and an overall dearth of resources (Orach & Garimoi 2009). People living in poverty are at a greater risk of death than their wealthier counterparts, largely because they lack access to public health initiatives like clean water, sanitation, food security, education, and economic opportunities (Peters et al. 2008). Disease-specific burdens also differ by socioeconomic status as people living in poverty are more likely to die from tuberculosis than those who have higher incomes.

The purpose of this chapter is to inform the readers about the challenges facing Sierra Leone's healthcare system. The chapter examines how the nation is characterized by a severe shortage of healthcare workers and providers in clinical medicine, nursing practice, general practice, and family medicine. It argues that health equity is achieved when everyone in Sierra Leone has access to the same level of healthcare. The chapter also discusses the health trends and debates over the last decade in Sierra Leone. It covers increasing the importance of healthcare systems to meet the population's needs to achieve health equity in the country. According to the World Bank (2019), Sierra Leone has one of the world's lowest life expectancies of 54.8 years, owing to high rates of infectious diseases such as malaria, tuberculosis, and HIV/AIDS. Malaria has historically been endemic in the country, accounting for approximately 40% of hospitalizations of adults and children, while a high prevalence of late diagnosis and undiagnosed tuberculosis cases has further strained the country's healthcare sector. Furthermore, women have been exposed to more health challenges, such as their efforts as primary caregivers during the Ebola pandemic, resulting in higher infections. Maternal and child mortality remain the highest in the world. Additionally, the country's mental healthcare services and rehabilitation are also underdeveloped, owing to the pressure to develop high quality physiological healthcare facilities but also the limited concern for the mental health needs of the society issues that require professional intervention, with many former child soldiers in the civil war turning to drugs and substance abuse as coping mechanisms for their traumatic experiences.