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Background <p>Cardiovascular disease (CVD) mortality is rising in Sierra Leone, but the health-system drivers of this trend are not well characterised. We mapped health-system barriers and facilitators for CVD care in Sierra Leone using a systems lens tied to universal health coverage (UHC).</p> Methods <p>We conducted a scoping review following PRISMA-ScR guidelines. We searched MEDLINE, Embase, Scopus, Global Health, and African Journals Online (1 Jan 2000 – 10 May 2025), Of 498 unique records, we included 40 sources reporting CVD-relevant data. Findings were mapped to WHO health-system building blocks, and synthesised narratively.</p> Results <p>Our findings show a health system shaped by path dependence: investments in infectious disease programmes have strengthened vertical delivery platforms with limited integration of non-communicable disease services. Facility readiness averaged 41% for HIV services versus 16.8% for cardiovascular care. An urban risk paradox was identified: urbanisation increased the odds of hypertension (OR 1.46) and diabetes (OR 1.84), while primary care infrastructure remained more oriented toward rural maternal health. Service delivery was undermined by diagnostic gaps; limited access to neuroimaging for stroke was associated with a threefold increase in mortality. High out-of-pocket costs narrowed effective coverage toward wealthier groups, and recurrent medicine stockouts reinforced distrust and disengagement from formal care. Scalable enablers included task-sharing, digital tools, pooled procurement, and community engagement.</p> Conclusion <p>Strengthening task-shared primary care, ring-fenced CVD budgets, pooling drug procurement, and improving digital infrastructure could accelerate UHC-effective coverage in Sierra Leone. Evidence on cost-effectiveness and socio-cultural determinants remains limited and should guide implementation research.</p>

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Health-system barriers and missed opportunities in cardiovascular care in Sierra Leone: a scoping review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月30日

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  • Mohamed B. Jalloh,
  • Fatima Jalloh,
  • Mamadu Baldeh,
  • Thiess Lorenz,
  • Foray M. Foray,
  • Tahir Bockarie,
  • Gari D. Clifford,
  • Abdul Jalloh,
  • Andrew Farlow,
  • Bamba Gaye

摘要

Background

Cardiovascular disease (CVD) mortality is rising in Sierra Leone, but the health-system drivers of this trend are not well characterised. We mapped health-system barriers and facilitators for CVD care in Sierra Leone using a systems lens tied to universal health coverage (UHC).

Methods

We conducted a scoping review following PRISMA-ScR guidelines. We searched MEDLINE, Embase, Scopus, Global Health, and African Journals Online (1 Jan 2000 – 10 May 2025), Of 498 unique records, we included 40 sources reporting CVD-relevant data. Findings were mapped to WHO health-system building blocks, and synthesised narratively.

Results

Our findings show a health system shaped by path dependence: investments in infectious disease programmes have strengthened vertical delivery platforms with limited integration of non-communicable disease services. Facility readiness averaged 41% for HIV services versus 16.8% for cardiovascular care. An urban risk paradox was identified: urbanisation increased the odds of hypertension (OR 1.46) and diabetes (OR 1.84), while primary care infrastructure remained more oriented toward rural maternal health. Service delivery was undermined by diagnostic gaps; limited access to neuroimaging for stroke was associated with a threefold increase in mortality. High out-of-pocket costs narrowed effective coverage toward wealthier groups, and recurrent medicine stockouts reinforced distrust and disengagement from formal care. Scalable enablers included task-sharing, digital tools, pooled procurement, and community engagement.

Conclusion

Strengthening task-shared primary care, ring-fenced CVD budgets, pooling drug procurement, and improving digital infrastructure could accelerate UHC-effective coverage in Sierra Leone. Evidence on cost-effectiveness and socio-cultural determinants remains limited and should guide implementation research.