Though the pharmacovigilance (PV) programme in Sierra Leone is young and lacks adequate resources for its full optimisation, the basic structures and processes are in place. With the provision of appropriate technical and financial assistance, the system can produce a significant impact. Specific legislation for PV must be put in place, ensuring that the pharmaceutical industry takes responsibility and liability for their products on the Sierra Leone market. Pharmacovigilance should be strengthened in hospitals and public health programmes that should go beyond merely collecting adverse drug reaction reports, but more so developing comprehensive systems that will encompass risk detection, evaluation, minimisation and communication. Public health programmes in collaboration with the national pharmacovigilance centre should consider deploying active pharmacovigilance methods as novel vaccines and therapeutics for diseases such as Ebola will be introduced in Sierra Leone first before being introduced in high-income countries. Integrating passive and active pharmacovigilance methods with careful planning can enhance the drug safety monitoring system and improve patient safety in Sierra Leone.