As seen on April 23rd, 2011 edition of The Lancet. 

On April 27, 2010, Sierra Leone started free health care for pregnant women, new mothers, and young children. John Donnelly takes an in-depth look at how the war-torn nation managed it.

At a dinner during the European Development Days events in Stockholm, Sweden, in October, 2009, Mary Robinson, the former President of Ireland, turned to the gentleman sitting next to her. He was President Ernest Bai Koroma of Sierra Leone. The gathering was full of chatter about the emerging global financial crisis and its effect on aid to countries like Sierra Leone, but Robinson, had something else on her mind. Sierra Leone was one of five countries supported by a programme that she had helped to start called the Ministerial Leadership Initiative for Global Health, and she wanted to talk about the country's health system.

She asked Koroma if he had set his top priority. “Maternal health”, he said without hesitating. He then told Robinson a secret. He said that he was about to set in motion a free health-care plan for pregnant women, mothers who were breastfeeding, and all children younger than 5 years.

Determined to improve access to health services in Sierra Leone’s weak health system, President Ernest Bai Koroma announced the launch of free health care for pregnant women, lactating mothers, and children under 5, in November 2009.  This announcement brought renewed attention on the importance of maternal and child health, but the process of researching, crafting and refining the policy, which enabled the ultimate announcement, reveals a remarkable level of initiative and dedication amongst the country’s policymakers.

Dr. Samuel AS Kargbo, the Director of Reproductive Health in Sierra Leone, searched for evidence-based research to build support for rolling out the free care policy at the request of President Koroma. In many well-resourced policy units in developed countries, this would be a simple task, but Dr. Kargbo faced a formidable challenge.  After initially finding that the research base was lacking, Dr. Kargbo embarked on a mission to create the pool of knowledge himself. He worked before dawn, when Internet was uninterrupted by electricity cuts, and assembled policy options through his own experiences as a district health official and original policy analysis.   Kargbo’s findings, along with the work of other key advisors, armed the President with the evidence for major policy reform and, Sierra Leone’s free care policy was born.