Constructing Disability Care Across Traditional and Biomedical Sectors in the Pluralistic Health System of Sierra Leone

Pluralistic health systems, in which biomedical and traditional providers coexist, shape how care for persons with disabilities is organised in low-income settings. In Sierra Leone, little is known about how providers from different sectors conceptualise care for persons with disabilities. This study examines how providers describe their professional roles, conceptualise disability care, and position themselves in relation to other providers. It draws on semi-structured interviews with ten healthcare providers in Freetown, Sierra Leone (five biomedical, five traditional), analysed using qualitative content analysis. Providers understand their roles through distinct professional trajectories. Traditional healers explain disability through spiritual, social and functional causes; biomedical providers primarily through clinical frameworks. Both sectors combine treatment, rehabilitation and everyday support in their practice. Referral between sectors is asymmetrical: traditional healers refer to hospitals and within their own networks, while biomedical providers refer exclusively within the formal sector. Among the ten participants in this exploratory study, disability care was described within a pluralistic but hierarchically structured health system, with providers working with overlapping populations but occupying unequal positions of authority. The findings point to unacknowledged interdependencies between sectors and suggest implications for more equitable and coordinated disability care in similar settings that merit further investigation.