ArticleBMJ global health2025
Improving Sierra Leone's skilled health-worker-to-population ratio: how unsalaried and auxiliary health workers are barriers in its path to universal health coverage.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Unpaid Clinical "Volunteer" Roles in Low- and Middle-Income Health Systems: A Narrative Review of Workforce Governance and Patient Safety.Journal of healthcare leadership · 2026Review
- Repositioning Primary Health Care in Sierra Leone: From Geographic Access to Effective Coverage.Annals of global health · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAchieving Universal Health Coverage (UHC) is one of Sierra Leone's main health policy goals. To achieve UHC, a country needs a skilled-health-worker-to-population ratio of 44.5 doctors, midwives and nurses per 10 000. In Sierra Leone, this ratio is 6.4 per 10 000. There is limited government funding to expand the health worker payroll, and the majority of healthcare providers on the payroll are auxiliary cadres, who fall below WHO's definition of 'skilled' health workers.Since 2010, approximately 10 000 auxiliary nurses have been engaged in the public health system on an unsalaried 'volunteer' basis. They compete for paid employment with graduates who meet skilled health worker criteria. This study examines barriers and enablers to Sierra Leone's expansion of its skilled health workforce.
methodsMixed methods: trainee health worker (projected) enrolment data were collected for 2019-2027. Primary care facility staffing data at district level was collected in 2023-2024, salaried and unsalaried. Semistructured interviews were conducted with students, faculty (n=20), health workers (n=110), salaried and unsalaried staff and key informants. The health labour market framework for UHC was used to analyse the results.
resultsSince 2019, Sierra Leone's emphasis has shifted to training nurses who meet WHO standards. This has led to a significant increase in public and private institutions offering health worker training courses. In 4 years, enrolment in nursing training facilities has quadrupled. District level data show that, at primary care level, over 50% of public health workers are in unsalaried positions, waiting for paid public employment.
conclusionWhile the production of additional health workers can be a potential enabler to a health worker density improvement, a lack of government funding to absorb both new graduates and all trained volunteer health workers who have been waiting for job opportunities means that barriers to a health workforce expansion outweigh the enablers.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.