A New Chapter for Lakka Government Hospital in Sierra Leone

Lakka Government Hospital in Freetown has been at the forefront of Sierra Leone’s fight against tuberculosis (TB) and especially multi-drug-resistant tuberculosis (MDR-TB). Through the partnership between the Ministry of Health (MOH) and Partners In Health (PIH), Lakka transformed from an under resourced hospital to one which TB/HIV Program Manager Dr. Girum Tefera envisions as “a center of excellence and an infectious disease treatment hub.” The hospital has revolutionized TB care in a low-resource setting by showing that comprehensive treatment not only involves administering the right medicine. It also includes creating dignified spaces, ensuring access to essential equipment, addressing patients’ psychosocial needs, and offering social support—what we refer to as the “five S’s” of strong health systems.

Since 2017, over 1,100 patients have been enrolled in the MDR-TB treatment program with a treatment success rate above the global average.

Sanctuaries for Care  

At Lakka, sparkling blue and white buildings stand tall, newly painted and spaced apart. Nurses and doctors move between them, while a few patients, wearing masks, sit under the mango tree at the center of the hospital. Landscaping is in progress and the once bare ground now has accessible pathways connecting the campus and freshly planted flowers and greenery. This process of renovating and rebuilding has created a sense of renewal. Lakka is entering a new phase of infrastructure improvements that prioritize safety and health, placing the patients at the center of design.

“What once resembled a deserted village is now a vibrant, welcoming space,” remarks Momoh Moiwo, the psychosocial rehabilitation technician at Lakka.

These changes include a handful of new spaces: two consultation rooms, a procedure room, nursing station, and staff bathroom. Nearby, there’s a spacious and well-ventilated waiting area for patients, along with a patient bathroom; and a renovated pharmacy and storage area.

“Most of these drugs are sensitive to heat and ultraviolet rays, so they need to be stored in a temperature-regulated environment,” says Tefera. The laundry room is also newly renovated, and the hospital introduced six coughing booths, allowing patients to safely produce sputum samples for TB testing. “Patients feel like they are in a proper hospital setting. Some of them don’t want to leave,” jokes Dr. Ronnie Harding, the medical superintendent at Lakka.

The Backbone of Patient Support

The treatment for MDR-TB has evolved dramatically over the years. What once required patients to take up to 20 pills and injections every day for up to eight months, often causing severe side effects such as deafness and kidney issues has now been reduced to seven tablets for six months for most patients. Those changes began in 2023 under the new World Health Organization (WHO)-recommended BPaLM regimen, of which Sierra Leone was the first country in the world whose MOH accepted the shorter treatment for nationwide use.

“This change has not only improved patient compliance but also reduced the burden on both patients and clinicians,” explains Tefera.

In addition, the availability of diagnostic technologies like GeneXpert machines reduced the turnaround time for TB diagnoses from weeks to 90 minutes. The high-tech machines are highly sensitive and user-friendly requiring only basic orientation for lab technicians. They not only diagnose TB in patients but also detect whether the bacteria are resistant to first line treatments, helping to identify potential cases of MDR-TB early.

To secure 24/7 access to electricity to power these and other critical machines, PIH provides fuel for Lakka’s generators. This is vital for patients that are oxygen dependent. As a long-term solution, the MOH has selected Lakka as one of 11 hospitals in Sierra Leone to benefit from a solar project. This initiative will reduce fuel consumption, while providing staff with more safety. “This place is very dark at night, and the solar power will allow for the installation of light poles,” adds Harding. Once the solar infrastructure is up and running, PIH can redirect resources spent on generator fuel into other critical areas of care.  

In addition to energy improvements, PIH has addressed plumbing and water supply issues by drilling a borehole, a type of well that ensures a continuous supply of clean water and reduces the risk of hospital-acquired infections.

Although Lakka lacks the capacity to conduct CT scans, there’s an X-ray machine available.  Alpha Badara, a medical officer at Lakka, highlights that the hospital is ahead of many other local health facilities in terms of resources. He adds, “In most institutions I’ve worked in, the availability of medications and lab results are always a challenge. It's never an issue here and that stands out.” 

Beyond the Basics  

The approach to care at Lakka places a strong emphasis on the overall well-being of patients. When they first arrive, Social Worker Sarah Kamara and Psychosocial Rehabilitation Technician Momoh Moiwo conduct thorough assessments to identify any psychosocial needs, such as mental health counseling, and determine the best approach to support each patient. “Sarah and Momoh’s roles are critical. It’s not just about financial support but also the emotional and spiritual aspect,” explains Alice Karim, a nurse at Lakka. The team also arranges recreational activities, such as board games, to reinforce that Lakka is a place of healing.

“If we want to watch a movie or play football, they organize everything and that makes us feel better,” says Abdul Davis, a patient at Lakka.

The mental health teams at PIH-supported facilities don’t work in silos. The social workers work closely with a clinical psychologist from the Sierra Leone Psychiatric Teaching Hospital, who visits monthly for group counseling and mentorship.

Additionally, all patients with MDR-TB receive three meals per day while at Lakka. A nutritious diet is a key part of TB treatment, which is why PIH Sierra Leone has long advocated to prioritize nutritional support as an essential component of TB care rather than an additional element. Through strategic collaboration and accompanying the MOH, this policy shift was successful in 2024 and has allowed for streamlined funding that includes nutritional support for patients, institutionalizing more equitable health services. 

A Unified Approach

The more than decade-long partnership between Sierra Leone’s MOH and PIH has been instrumental in addressing this neglected disease, leading to holistic strategies that specifically address TB’s links to poverty in Sierra Leone. As Harding shares, “While we don’t always have everything we need to fully run the hospital, the ministry will always play its part, and we are grateful to PIH for filling in the gaps.” Tefera highlights the strength of this collaboration, saying “we work as one entity” and this relationship drives the commitment to continuously improve the quality of care at Lakka.