This report highlights Sierra Leone’s high health expenditure yet poor health outcomes, with a maternal mortality rate far exceeding neighboring countries. Key issues include an inequitable resource distribution favoring hospitals over cost-effective primary health units, limited government health spending (only 6% of general government expenditure), and heavy reliance on donor funding. The population bears a significant financial burden, with out-of-pocket expenses making up two-thirds of total health expenditure in 2018. To achieve Universal Health Coverage (UHC), Sierra Leone aims to develop a health financing strategy to raise government spending and improve spending efficiency.