SIERRA LEONE

Sierra Leone underwent civil war from 1991 to 2002. The health system in post-conflict Sierra Leone can be described as fragile and plagued by having inadequate human resources for health (HRH), together with a history of low, irregular remuneration for health professionals. In addition, attracting and retaining health workers in rural areas, where two thirds of the population can be found, especially areas that are hard to reach, has proven difficult, which has created a geographical imbalance in the distribution of health workers. This creates unequal access to healthcare services as the services are not available where the needs and impact are most needed. A study reported that 90% of all of the surgeons in Sierra Leone are concentrated in the capital city Freetown, meaning rural areas of Sierra Leone are catered by only 10% of the surgeons available in-country.
This study showed that in Sierra Leone, the motivational factors most valued by the rural health workers were serving the community, being effective in your role followed by financial incentives, opportunities for on-the-job training and continued professional development and religion.
Community service as a motivational factor was mostly valued by health workers working in the community (i.e. CHOs). Other cadres of health professionals, including nurses, midwives and district health sisters (DHSs), also reported community service as a motivational factor.

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Source: Retention of health workers in rural Sierra Leone: findings from life histories, 2016
Haja R. Wurie, Mohamed Samai, and Sophie Witter