Introduced by the President of Sierra Leone in 2010, the FHCI abolished health user fees for
pregnant women, lactating mothers and children under five years of age. This action was taken in
response to very high mortality and morbidity levels among mothers and children in Sierra Leone –
some of the worst in the world – and reports that financial costs were a major barrier to health
service uptake and use by these groups.
This report presents an independent review of the FHCI. The main users of the review findings will
be the MoHS, the Government of Sierra Leone (GoSL), and their development partners. DFID
funded the study, which has been coordinated with the MoHS and key stakeholders. The findings
of the review remain relevant not just in terms of assessing this important policy initiative
retrospectively but also to inform the rollout of the current post-Ebola investments in Sierra Leone.