Sierra Leone’s 2024 Auditor-General’s report has uncovered widespread operational failures, staff shortages and financial irregularities at major government hospitals in Freetown, raising concerns about the quality of healthcare delivery in the capital.
At Connaught Teaching Hospital, the country’s main referral facility, auditors found severe capacity constraints at the Dialysis Centre, where only three of four machines were functional. The machines, procured in 2016, can operate for no more than eight hours a day, forcing some kidney patients to be turned away and asked to return the following day. The audit also cited a lack of regular staff training on dialysis equipment.
The report flagged poor environmental and sanitation conditions at Connaught, including a defective incinerator that has led to medical waste being dumped about 10 metres from the hospital’s annex kitchen. Auditors said contract cleaners were poorly supervised, with no evidence of routine monitoring by the Environmental Officer or the Monitoring and Evaluation Unit.
Connaught was also described as critically understaffed, lacking specialists such as ENT surgeons, neurologists, oncologists, radiographers and oxygen technicians. Key units including the laboratory, blood bank, dental, optical and physiotherapy departments were found to be inadequately equipped. The Stroke Unit lacked basic rehabilitation tools, while the Triage Unit operated with only one blood pressure machine despite handling more than 6,900 admissions in 2024. The hospital also lacks CT scan and MRI facilities, forcing referrals to private centres.
At Rokupa Maternal and Child Health Hospital, auditors reported poor conditions in the labour ward, including the absence of running water. Mothers were said to wash in open spaces using water brought from home. The ward had only one delivery kit, no sterilisation equipment and severe shortages of supplies. The audit also identified financial irregularities, including NLe309,700 in revenue from bed fees and assault cases that was neither recorded nor banked. Twenty-five nurses could not be physically verified, although salaries totalling more than NLe431,000 had been paid.
King Harman Road Maternal and Child Health Hospital was found to be operating under unsafe theatre conditions. Auditors said faulty suction machines forced staff to improvise with towels to control bleeding, only one operating light was functional, and the sole steriliser was defective. Nineteen staff were reported to be on study leave without bonding agreements or progress reports.
At Sierra Leone–China Friendship Hospital in Jui, the maternity and gynaecology department lacked essential instruments, oxygen equipment and life-saving drugs. The audit also cited revenue management breaches, including NLe177,977 in collected funds that were not banked and the use of volunteers to collect hospital revenue. Forty-one staff could not be verified, despite salaries exceeding NLe809,000 being paid.
Conditions at Princess Christian Maternity Hospital remained poor, particularly at the mortuary, where the cooling system was found to be completely damaged. Auditors said no structural maintenance had been carried out despite earlier recommendations. Twenty staff were absent during physical verification, although salaries of more than NLe432,000 were paid.
At Ola During Children’s Hospital, the emergency room was found to be under-resourced, with worn mattresses and insufficient oxygen concentrators, sometimes shared among multiple patients. Eleven staff could not be accounted for during verification, with salaries totalling over NLe252,000 paid.
The Auditor-General said the findings point to weak oversight, unverified staff on payrolls and repeated failure to implement past audit recommendations across the facilities.
The report urged medical superintendents, working with the Chief Medical Officer and the Permanent Secretary, to urgently address the issues to prevent further deterioration of healthcare services and restore public confidence in the health system.
