BACKGROUND: Sexual and gender-based violence (SGBV) is a threat to women and girls' health and justice globally, and is widely prevalent in Sierra Leone. This study identifies key barriers to high-quality healthcare and justice for SGBV survivors in Sierra Leone using a gender-integrated socio-ecological model. METHODS: In this qualitative study, purposive sampling was performed with maximum variation by sector and region. From December 2023 to February 2024, Sierra Leonean and international researchers conducted semi-structured interviews and focus group discussions with health, legal, law enforcement, and government officials across Sierra Leone. Data analysis employed a hybrid thematic approach using a gender-integrated socio-ecological model (GI-SEM) framework while remaining open to emerging themes. Analysis was completed between August 2024-March 2025. RESULTS: Across five sites in Sierra Leone, a total of 31 multidisciplinary staff participants were included through semi-structured individual (n=17) and focus group interviews (n=6), including healthcare providers (n=15; 48.4%), law enforcement officers (n=9; 29.0%), government officials (n=5; 16.1%), and legal professionals (n=2; 6.5%). At the individual level, perceived barriers included system fatigue, internalized stigma, and secondary trauma. Interpersonal barriers included power imbalances in provider interactions and coercion by survivor networks. Organizational barriers consisted of service accessibility gaps, operational inefficiencies, and resource constraints. Community-level barriers involved religious interference and insufficient prevention engagement. At the societal level, financial constraints, legal framework gaps, and stigmatizing attitudes further impeded access to care and justice. CONCLUSION: Despite ongoing efforts, SGBV survivors in Sierra Leone face persistent challenges accessing care and justice. These findings highlight critical intervention points across multiple levels to strengthen response systems.
Olson et al. (2026) studied this question.