Repositioning Primary Health Care in Sierra Leone: From Geographic Access to Effective Coverage.

Primary health care (PHC) is central to Sierra Leone's efforts to achieve universal health coverage. Despite substantial expansion of the peripheral health unit network, improvements in geographic access have not consistently translated into better health outcomes. This viewpoint argues that Sierra Leone must shift its focus from physical access to effective coverage, defined as the proportion of people who receive care of sufficient quality to produce meaningful health gains. Key challenges include persistent out-of-pocket expenditure, shortages of salaried health workers, weak service readiness, fragmented vertical programmes, limited digital infrastructure, and variable implementation capacity. Addressing these constraints will require reforms in financing, workforce formalisation, quality improvement, programme integration, and accountability. Strengthening these areas will be essential for ensuring that PHC delivers equitable and measurable health gains for all Sierra Leoneans.