Abstract: Sierra Leone has expanded community-based primary healthcare (PHC), yet persistent workforce, service-delivery, financing, infrastructure, information-system, and equity constraints continue to affect service capacity and sustainability. This study examined these conditions and developed evidence-informed strategies for strengthening community health and PHC. A scoping review guided by PRISMA-ScR identified peer-reviewed and authoritative grey literature, with 18 studies and reports retained from 65 initially identified records. Evidence was mapped to the six World Health Organization Health System Building Blocks, with equity, community engagement, and resilience incorporated as cross-cutting dimensions, and subsequently analyzed using SWOT and TOWS frameworks. The analysis identified established Community Health Worker and Community Health Officer structures, community-based service platforms, PHC policy commitment, epidemic-response experience, and emerging digital-health capacity as important strengths. Major constraints included workforce shortages and maldistribution, limited workforce absorption and retention, inadequate service readiness, fragmented information systems, financing limitations, and inequitable access. Opportunities included digital integration, geospatial workforce planning, workforce development, integrated epidemic preparedness, and strategic partnerships, while epidemics, health-worker migration, financing pressures, supply-chain disruptions, and environmental risks represented significant threats. TOWS analysis consolidated these findings into six strategic priorities: a sustainable and equitably distributed workforce; strengthened PHC readiness and essential services; integrated digital health and information systems; epidemic-ready and resilient PHC; sustainable financing and coordinated governance; and equity-centered, community-responsive healthcare delivery. The findings demonstrate that sustainable community health improvement in Sierra Leone requires strengthening and integrating existing capacities rather than developing parallel systems and provide an evidence-informed pathway from health-system assessment to strategic planning and implementation.
Keywords: Sierra Leone; community health; primary healthcare; health-system strengthening; SWOT; TOWS; resilience; universal health coverage.
Title: Strategies for Strengthening Community Health in Sierra Leone: A SWOT–TOWS Matrix Approach
Author: Dr. David Bull
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
Vol. 14, Issue 1, April 2026 - September 2026
Page No: 527-548
Research Publish Journals
Website: www.researchpublish.com
Published Date: 17-August-2026
