Countries all over the world have always been concerned with developing their health care financing systems, so as to ensure access to health care for their citizens. They have sought to develop systems that would provide adequate financial resources and to be affordable to all those sharing in the costs, through mechanisms that will not entail financial barriers to seeking care, particularly at the time of illness. In theory, social health insurance has the most potential to achieve health policy objectives, in practice it has been difficult to achieve in low-income countries because, implementing Social Health Insurance in economically, socially, and culturally diverse environments, produces unexpected challenges. Linkages between overcoming the challenges of implementing social health insurance in low-income countries and the success of the scheme vary from institutional, legal and technical point of view. Designing and implementing social health insurance in Sierra Leone is constraint by lack of human capacity and sufficient financial resources among others.