Amnesty International said Tuesday that Sierra Leone's free health care plan for pregnant women and young children is dysfunctional and hobbled by corruption and a lack of accountability.
"The health care system remains dysfunctional in many respects," Erwin van der Borght, Amnesty International's Africa program director, said in a statement accompanying the release of a report on the initiative.
"Government figures show that since the introduction of the initiative, more women are accessing antenatal care and delivering their babies in health facilities.
"However, many women continue to pay for essential drugs, despite the free health care policy, and women and girls living in poverty continue to have limited access to essential care in pregnancy and childbirth."
The 90 million dollar (67 million euro) free healthcare programme for pregnant women, nursing mothers and children under five years old was launched in April last year with donor aid from UNICEF, the World Bank and the World Health Organisation and the UK Department for International Development.
The Amnesty report documents interviews with women who had been turned away from health centres and told to pay for medications.
It said there was no system in place for complaints to be registered.
"A critical shortcoming within the healthcare system is the absence of any effective monitoring and accountability systems, without which reforms cannot succeed," said Van der Borght.
According to the report Sierra Leone is facing huge public accountability concerns after UNICEF raised fears large amounts of drugs destined for the programme had gone missing.
In some cases medicines meant for the project were found in private healthcare facilities and pharmacies.
Corruption was a particular problem at the Freetown port where officials demanded money to clear shipments of medication or expedite processing.
In June 2011 civil society organizations in Sierra Leone reported that 43 containers of drugs are sitting at the ports awaiting clearance, some of which date back to 2010.
"The government has taken some important steps to address these challenges. However, deficiencies in the monitoring and accountability system allow poor practice and mismanagement to go unchallenged, and have provided some people with opportunities to exploit the system and plunder valuable medicines," said Van der Borght.
The healthcare initiative has been widely praised in opening up healthcare to many in the country which is still recovering from a brutal decade long conflict which ended in 2002.
In Sierra Leone, where some 70 percent live on less that a dollar a day, only one in four children live to see their fifth birthday, according to UN figures. In the developed world, this figure is one in 8,000.
Sierra Leone has one doctor for every 17,000 people and one nurse for every 8,000, according to health ministry statistics.