According to Médecins Sans Frontières the health care system in Sierra Leone causes loss of life because the poor cannot afford medical treatment.
The maternal death rate and the child mortality rate in Sierra Leone are the highest in the world.
Experiences of Médecins Sans Frontières had shown that free care or low fees lead to a dramatic increase in the number of patients.
Nonetheless the national health system of Sierra Leone demands payment for all treatment with simple consultations costing as much as 25 days of income.
According to Action Against Hunger the number of children with acute malnutrition has reached almost twice the level of the WHO's emergency threshold of 2% in the Moyamba district of Sierra Leone.
The Los Angeles Times writes that Sierra Leone, in spite of decades of foreign aid, has not yet increased the standard of living of its people considerably and 60% of the public spending of Sierra Leone come from other governments and nonprofit organizations.
Since 2002 the country received $1 billion in aid but the infant mortality rate is almost the highest in the world, lower than Angola but higher than Afghanistan. The newspaper further reports that the United Nations state that 1 in 8 Sierra Leonean women die giving birth, as compared to 1 in 4,800 in the United States and that life expectancy in Sierra Leone is merely 41 years while in Bangladesh life expectancy reaches 60 years.
The government of Sierra Leone had expressed its intend to abolish user fees for women and children with a new plan for a fairer health care system that was to be revealed on the Sierra Leone Investment and Donor Conference, which was held in London on November 18 and 19.
“The Sierra Leone government has publicly stated its commitment to abolish user fees, and the UK government and other donors have promised to help,” said Seco Gerard, advisor at Médecins Sans Frontières’s analysis and advocacy unit. “What is crucial now is that Sierra Leone actually receives the necessary funding and technical assistance to realise this objective. It is time that words are being followed up by concrete action. If not, people who could otherwise be saved will continue to die needlessly every day.”
The Telegraph reports that president Bai Koroma was also hoping to secure a significant increase in aid donations with his new health plan.
While Germany declined to support president Bai Koroma’s "Agenda for Change" and urged to give more consideration to women's welfare the country received support from the European Union, DFID, UNIPSIL, World Bank, IFAD and the African Development Bank. From the pledges of $850 million the government of Sierra Leone was hoping for only about $300 millions could be secured, with attached conditionalities concerning the use of funding.
In a presentation at the Ministry of Finance and Economic Development in Freetown the Unicef representative for Sierra Leone, Mr. Mahimbo Mdoe, expressed gratitude about a pledge of about $1.3 million conveyed by the Ambassador of Japan to Sierra Leone, His Excellency Mr. Keiichi Katakami, and about earlier donations to UNICEF-Sierra Leone in the past years, amounting to over $20 million.
The intended application of the funding is the goal to half child and maternal mortality by 2010, to introduce a social health insurance scheme, to improve equipment and to train health professionals.

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State of the health care system in Sierra Leone critical