Employed but Unpaid, Volunteers or Paradoxical Surplus? Sierra Leone's Unsalaried Health Workforce

Unsalaried clinical health worker numbers have increased in PHUs since 2016; an estimated 4000-5000 unsalaried clinical staff is in precarious employment, awaiting payroll inclusion. The majority of this 'paradoxical surplus' of health workers is trained to auxiliary cadre, meaning their eventual payroll inclusion will not increase the country's skilled-health-worker-to-population ratio, or improve Universal Health Coverage rates.