Strengthening community health systems:
A collaborative approach to addressing Kush use in Kailahun district Sierra Leone

Partners (all Sierra Leone): Institute for Development, University of Management and Technology, University of Sierra Leone, Dr Abdul Jalloh (consultant psychiatrist), Njala University, Statistics Sierra Leone, and Centre for Health Research and Training

Background

Substance use disorders are a growing global public health challenge, with a sharp rise among young people leading to significant social, economic, and health consequences (Statista Research Department, 2024). In Sierra Leone, where 75% of the population is under 35, there is a widespread use of Kush, a synthetic drug cocktail containing cannabinoids and nitazenes. Introduced in Freetown in around 2016, Kush has since spread nationwide, including rural communities like Kailahun. The impact of Kush in Sierra Leone has been devastating. The country’s only psychiatric hospital has seen a 4000% increase in drug addiction cases since 2020, with more than 70% linked to Kush use (Baldeh et al., 2024; Tommy Trenchard, 2024). Rehabilitation centres operate at three times their capacity, while widespread deaths, severe psychiatric disorders, and rising school dropouts highlight the drug’s destructive toll. Acknowledging this, President Julius Maada Bio declared Kush an “existential crisis” in April 2023 and called for a national emergency response.

Objectives

This project will address the Kush epidemic by strengthening absorptive, adaptive, and transformative resilience within Kailahun’s local health and social systems. The project will begin with a comprehensive mapping of existing interventions, assessing how the health system absorbs the immediate strain caused by Kush use (absorptive resilience). Using participatory methodologies inspired by the African Cities Research Consortium (ACRC) and the PCP Empowering Youth initiative, the project will identify systemic gaps, socio-economic drivers, and stakeholder capacities to adapt responses (adaptive resilience).

Building on these insights, the study will co-develop sustainable interventions with stakeholders through community-driven reform coalitions and participatory research approaches. This phase will focus on harm reduction strategies, stigma reduction, and addressing root causes, such as youth unemployment and limited opportunities, to achieve long-term transformative resilience.

Research questions and methods

Phase One will map the problem asking the following research questions:

•  How resilient are local health and social systems in responding to a substance use crisis?
• What socio-economic drivers and structural barriers contribute to persistent challenges in addressing Kush use?
• What are the specific community needs to develop effective, sustainable responses?

Phase Two will see the development of interventions. Key components are:

• Community Entry and Pre-Intervention Evaluation: Trust-building with stakeholders and forming a reform coalition inclusive of Kush users and individuals with lived experiences, promoting inclusive governance and shared ownership.
• Community-Based Participatory Research (CBPR): Actively involving stakeholders in shaping interventions. Gender-sensitive strategies, as demonstrated in PCP’s youth-focused initiatives, will ensure safe spaces for women and marginalised groups.
• Targeted Interventions:
  • Harm reduction education via R4R radio programs and workshops.
  • Peer-to-peer mentorship systems to support users’ rehabilitation.
  • Community-led capacity building, integrating local resources to strengthen health outcomes.
• Evaluation and Sustainability: Post-intervention evaluation will measure behavioural change, community resilience, and reductions in Kush use. Ownership will transfer to local leaders, ensuring long-term transformative resilience.

Outputs

Blog post: “Kush” in Kailahun: What a community-led study is teaching us about hope, health, and hard choices

Presentation: outlines some of the study findings including potential intervention areas, policy implications and future potential research priorities. Read it here.

Image: Local stakeholders in Kailahun during the data collection phase of the study