Sierra Leone

The Constitution includes a chapter on fundamental principles of State Policy (chapter II). These principles refer to the obligation of the State to direct its policy towards ensuring, among other things, that there are adequate medical and health facilities for all persons, having due regard to its resources (section 8). However it is clearly provided that the principles included in this chapter are not enforceable in any court of law and do not confer legal rights (section 14).

The Constitution does not include provisions dealing specifically with mandate over health matters. It does provide however that legislative power is vested in the Parliament (art. 105).

The main goal of the "National Health and Sanitation Policy 2021" is to strengthen the health and sanitation systems' performance to ensure equitable access to quality and affordable essential health and sanitation services for all people in Sierra Leone (page 21).

The priorities and objectives identified in the policy include fostering good health to prevent diseases and promote healthy lifestyles, improving the physical environment, sanitation and hygiene, building and strengthening a resilient healthcare delivery system, and strengthening health security and emergency preparedness (page 23).

The policy references several legislative documents to provide context and analysis. For instance, the 1991 Constitution of the Republic of Sierra Leone is highlighted as the foundational legal framework obligating the state to provide adequate medical and health facilities for all persons (pages 12, 20). Additionally, the Local Government Act of 2004 is mentioned in relation to the decentralization of health services and the implementation of government policies at the local level (page 22). The Public Health Ordinance of 1960 and its 2020 revision are discussed as the primary legal instruments governing health service delivery (page 42).

The Policy provides specific actions related to laws and regulations throughout its text. For example, it emphasizes the need to establish a national accreditation framework for the health sector, through a recognised legal body, to accredit health provider institutions to comply with standards (page 26). It also provides that the government shall develop appropriate legislation on governance and revise the existing laws to strengthen mechanisms and build technical capacity (page 29). Furthermore, the policy calls for the enactment of legislation for the regulation of the marketing of breastmilk substitutes to support, protect and promote safe breastfeeding practices and regulate the use of breastmilk substitutes (milk formula) (page 36). The document also provides for the implementation of provision of existing legislation and international conventions on narcotics, psychotropic substances and precursors chemicals (page 37). Under the part on safe and responsible sexual behaviour, the policy calls for the enforcement of provisions of existing legislation on sexual abuse and preventative measures, as well as the treatment and rehabilitation of victims of sexual abuse (page 38).

The main goal of the "National Health Sector Strategic Plan 2021-2025" is to provide all people in Sierra Leone equitable access to quality and affordable health and sanitation services (public or private) at all times without any undue financial hardship by 2030 (page 14).

The strategic priorities identified in the plan include sustainable financing and financial protection, health system reform for universal health coverage (UHC), equitable access to health services, quality of health services, disease prevention and health promotion, and health security and emergency (page 15).

The "Introduction" section doesn't list any references to legislative or regulatory acts.

The Strategic Plan identifies several legislative and regulatory objectives and/or outputs related to health. For example, under the objective to develop relevant laws, policies and regulations that impact population health outcomes by 2025 the plan delineates a list of acts to be developed or revised such as the Health Act, Reproductive Health Act, Maternal Health Act, Health Service Commission Act, SLESHI Act, National Medical Supplies Agency (NMSA) Act, Allied Health Professionals Act, Nurses and Midwives Council Act, Pharmacy and Drugs Act, Food Safety Act, Hospital Board Act, Sierra Leone Medical and Dental Council Act, Tobacco Bill (pages 22-23). Furthermore, the policy establishes the need to implement the NMSA 2017 Act to provide the NMSA autonomy (page 61).