The paramedical school in Bo, Sierra Leone: A historical and institutional analysis of mid-level health worker training in a low-middle income country healthcare system

Background: Mid-level health workers are essential to Sierra Leone’s health system, particularly in rural areas where physician shortages persist. Despite their importance, the institutions that train these cadres remain under-documented. The Paramedical School in Bo, established in the 1980s with European Union support, played a central role in producing Community Health Officers (CHO) and other mid-level practitioners. Understanding its evolution provides insight into health workforce development in fragile and post-conflict settings.

Methods: This historical and institutional analysis synthesises evidence from the global health literature, policy documents, architectural interpretation, and empirical studies on health system resilience. The paper examines the school’s origins, design, pedagogical evolution, and institutional transitions, situating them within broader political, economic, and global health contexts.

Findings: The school’s establishment aligned with the post-Alma-Ata expansion of primary healthcare and donor-driven investments in paramedical staff training. Its climate-responsive architecture and competency-based curriculum reflected both global development logics and local needs. The civil war severely disrupted operations, yet the school demonstrated resilience and remained central to post-war reconstruction. Subsequent epidemics, including Ebola and Mpox, reinforced the strategic importance of non-medical cadres. Integration into Njala University strengthened academic oversight but introduced governance and resource challenges.

Conclusion: Strengthening non-medical training institutions is essential to building resilient, equitable health systems in Sierra Leone and comparable low-income and mid-income contexts.