World Journal of Surgery

, Volume 37, Issue 6, pp 1216-1219

First online:

Free Health Care for Under 5 Year Olds Increases Access to Surgical Care in Sierra Leone: An Analysis of Case Load and Patient Characteristics

  • Reinou S. GroenAffiliated withSurgeons OverSeas (SOS)Department of Gynecology and Obstetrics, Johns Hopkins Hospital Email author 
  • , Thaim B. KamaraAffiliated withDepartment of Surgery, Connaught Hospital
  • , Benedict C. NwomehAffiliated withSurgeons OverSeas (SOS)Department of Pediatric Surgery, Nationwide Children’s Hospital
  • , Kisito S. DaohAffiliated withMinistry of Health and Sanitation
  • , Adam L. KushnerAffiliated withSurgeons OverSeas (SOS)Department of Surgery, Columbia UniversityDepartment of International Health, Johns Hopkins Bloomberg School of Public Health

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In April 2010 Sierra Leone launched a nationwide program that provides free health care to all pregnant and lactating women and children under 5 years old. This study evaluates the effect that the free health-care program had on pediatric surgical activities of Connaught Hospital.


The study period was defined as the 20 months before and after April 27, 2010, the start date of the free health-care program. Data on age, gender, diagnosis, and procedure for patients under 5 years of age and the total number of operations were collected from the Connaught Hospital operating room logbook.


The number of operations on children under 5 increased by 500 %, from 42 to 210 cases. This increase was significantly larger than the 17 % increase of 1,393–1,630 seen with operations for patients 5 years and older (p < 0·01).


The decision by the Sierra Leone President to institute a program of free health care for children under 5 has resulted in an increased number of pediatric surgical cases at Connaught Hospital. Efforts should be undertaken to provide additional supplies and equipment and to develop training programs for surgeons and support staff to care for the children in need of surgical care.