Background : Decentralized district health system is the cornerstone of a country’s health sectors. The aim of the present study was to investigate the factors that influence the performance of the district health management team (DHMT) in Sierra Leone. The study was guided by a conceptual framework that is adapted from the World Health Organization leadership and management strengthening framework. Methods : The study used a qualitative method design and targeted both the District Medical Officers (DMO) and their subordinates in four DHMTs (Bo, Kailahun, Kenema and Kono). An interview guide was used to explore the perspectives of both the DMOs and their subordinates ( n =27) on the perceived factors that influence the performance of the DHMTs. A thematic analysis, using the WHO framework was carried out in the analysis of the data. Results: The perceived factors that influence the performance of DHMTs are notably the inadequate and late disbursement of funds to the district. This affects the implementation of planned activities. Further, the lack of adequate and capable staff within the DHMTs was highlighted. Other concerns were the poor coordination between national and district level in health program implementation; and the poor working conditions such as poor office spaces, unreliable power supplies and internet connectivity. Conclusions: Addressing the human resource gap within DHMT, ensuring a better flow of funds to the district, and improved coordination in health program implementation between national and district are promising measures that will optimize the performance of the DHMTs in Sierra Leone.
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