Financing required to maintain Sierra Leone’s 2023 combined government and external health financing per person during donor reductions to 2030

Health aid is contracting. In 2023, Sierra Leone spent US$35.76 per person on health: US$19.48 out of pocket, US$10.19 from external sources, US$5.98 from government, and US$0.11 from other sources. We estimated the financing required to maintain the combined government and external amount of US$16.17 per person through 2030. We used 2012–2023 health-expenditure data, 2012–2022 government health-budget shares, and World Bank population estimates with 2.0% annual growth from 2026 to 2030. We calculated domestic needs under three donor-reduction paths and three domestic packages combining government spending, net additional health-tax revenue, and efficiency. W​e estimated break-even conditions, ran 20,000 draws per combination, and supplied code and input templates for repeated scenario analysis. Maintaining US$16.17 per person for 9.74 million people required US$157.48 million. Projected external financing under coordinated transition, broad contraction, and abrupt withdrawal was US$63.93 million, US$49.01 million, and US$33.47 million, leaving domestic needs of US$93.56 million, US$108.48 million, and US$124.01 million. The three domestic packages generated US$68.06 million, US$89.27 million, and US$115.46 million. The strongest package exceeded the requirement under coordinated transition and broad contraction, but abrupt withdrawal left US$8.55 million short, with gaps in < 0.1%, 23.0%, and 95.7% of draws. The fiscal rule was less accurate than persistence (​mean absolute percentage error 18.7% versus 13.2%). The strongest package met the requirement under coordinated transition and broad contraction but not abrupt withdrawal. Donor reductions should follow released replacement financing and service readiness without shifting costs to households. The calculation can be rerun in Sierra Leone and adapted elsewhere.