Figure 1
Structure of the Sierra Leone health system and the distribution and financing of the health workforce. (A) Service delivery structure from the community and peripheral health unit (PHU) levels through secondary (district hospital) and tertiary (regional and national referral hospital) levels, illustrating referral pathways, supervision and supply chains, and the distribution of key health workforce cadres. (B) Density of skilled health workers (doctors, nurses, and midwives) in Sierra Leone (6.4 per 10,000 population) compared with the WHO minimum threshold of 44.5 per 10,000 population. (C) Distribution of salaried and unsalaried clinical staff at PHU level, showing that 50.6% of clinical staff are unsalaried and that unsalaried staff outnumber salaried staff in 7 of the 10 districts surveyed. (D) Schematic illustration of the distribution of public health spending, showing that primary health care expenditure is relatively pro‑poor whereas secondary and tertiary care expenditure is relatively pro‑rich. Panel D illustrates the direction of benefit incidence only and does not represent budget shares. The figure is an original synthesis based on data from the Sierra Leone Human Resources for Health Country Profile and published studies on the health workforce and health financing [3, 11–13].