Objectives: (i) To estimate the total health expenditure from various sources; (ii) to determine total health expenditure by various financing agents; (iii) to track the flow of health funds from financing agents to various providers; (iv) to examine the distribution of funds from providers to various public health functions.

Data sources: Data were collected from both secondary and primary sources. The primary data were collected using seven specially NHA designed survey questionnaires for donors, government ministries, local councils, private employers, health service providers, insurance companies, parastatals and NGOs. The household health expenditure data were obtained from the national population census of 2004.

Study selections: The NHA questionnaires were administered to were administered to a total of 177 Agencies/Institutions,

comprising: 16 Donors, 11 Ministries, 19 Local Councils, 36 Private Employers, 55 Providers, 1 Insurance Company, 20
Parastatals and 36 NGOs. No information was collected on Traditional Healers, drug stores and other clinics that are not legally registered with the Ministry of Health and Sanitation.

Data synthesis: The total health expenditure (THE) was approximately Le 815,911,166,288 in 2004; Le 966,849,360,080 in 2005; and Le 968,441,819,608 in 2006. The per capita total health expenditure was Le163,941 in 2004, Le189,783 in 2005 and Le185,636 in 2006. The households, through direct out-of-pocket payments to health care providers, contributed 67.13% in 2004, 64.08% in 2005 and 69.25% in 2006 to the total health expenditure. During the three years between 17.76% (year 2004) and 10.97% (year 2006) of the total health funding came from donors (international health development partners). The Government of Sierra Leone contribution grew from 15% in 2004 to 19% of the total health expenditure in 2006.

Conclusion: There is need to institutionalise NHA to ensure that it can be conducted on a regular and sustained basis. In the process of institutionalizing NHA, it will be necessary: (i) to reinforce the institutional and human capacities of the unit responsible for undertaking NHA; (ii) to explore the feasibility of integrating NHA data collection within the national health information management systems; (iii) to include questions on household out-pocket payments for health care in the national household survey data collection instruments routinely carried out by the Statistics Sierra Leone (SSL); and (iv) to continually involve SSL in NHA activities.