Repositioning Non‐Communicable Diseases in a Historically Acute Care Health System: A Qualitative Assessment of Policy Readiness for Integrated NCD Services in Sierra Leone

Background Non‐communicable diseases (NCDs) account for approximately 35% of deaths in Sierra Leone, yet service delivery remains largely focused on infectious diseases and maternal and child health. The NHSSP 2026–2030 presents an opportunity to integrate NCD care within primary healthcare and district health services. This study assessed the readiness of Sierra Leone's health system to support this transition. Methods A qualitative‐dominant mixed‐methods design was employed, integrating a review of 10 policy and technical documents with 28 semi‐structured interviews. Participants were purposively selected across national, district, facility and community levels and included NCD programme officials, district health managers, clinicians, pharmacists, community health workers and patient advocates. Data were analysed using a thematic framework approach. Documentary and interview findings were triangulated, and member checking was conducted. Readiness across seven domains was assessed using a predefined rubric, with ratings agreed by all authors. Results Four overarching themes and nine sub‐themes were identified: NCD policy visibility and strategic limitations; PHC readiness and implementation gaps; medicines access, supply chain fragility and treatment barriers; and workforce capacity, referral systems and community awareness. Although NCDs have gained greater prominence within national policy discourse, participants frequently characterised this recognition as insufficiently translated into implementation. Integration at PHC level was hindered by an unoperationalised service package, inadequate diagnostic capacity, recurrent medicine stockouts, workforce competency gaps, weak referral pathways, out‐of‐pocket costs and limited public awareness. Readiness ratings indicated emerging policy commitment but substantial deficiencies in operational guidance, service delivery inputs, implementation capacity and accountability mechanisms. Conclusions The NHSSP 2026–2030 provides a critical opportunity to institutionalise integrated NCD services within PHC. Realising this potential will require context‐specific adaptation and phased implementation of the WHO Package of Essential NCD Interventions, strengthened medicines supply systems, workforce development, formalised referral pathways, community engagement and a costed financing strategy aligned with universal health coverage goals.