Mental health experiences of frontline health workers in Sierra Leone: A qualitative study using the Framework Method

BACKGROUND: Frontline health workers in Sierra Leone have endured pandemics and recurrent infectious and maternal emergencies under chronic under-resourcing, yet the psychological burden they carry remains poorly understood. This study explored how they experience and cope with mental health challenges during and after emergency response. METHODS: A qualitative study used semi-structured interviews with 42 purposively sampled frontline health workers across three districts and eight professional cadres. Sample size was guided by information power rather than saturation. Data were analysed using the Framework Method, indexing all transcripts into a matrix of 42 participants by 17 categories. Reporting followed the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Charting produced 17 categories under four themes: the weight of witnessing, stigma and social fracture, coping in the margins, and institutional abandonment. Distress was patterned rather than uniform: accounts of stigma between cadres came mainly from burial and laboratory staff, and accounts of enforced family separation from those deployed away from home. Two categories, both specified in advance, were populated across the whole sample: fear of infection, and absent or token formal support; no participant described employer-provided psychosocial support as adequate and sustained. CONCLUSIONS: Frontline health workers in Sierra Leone described heavy and largely unaddressed psychological burdens, and asked directly for prompt hazard pay and sustained recognition. Read with the conceptual frameworks and literature, their accounts make a case for building structured psychosocial support into emergency preparedness and universal health coverage planning, as an obligation to the workforce and a condition of its retention.