Introduction: On April 27, 2010 Sierra Leone implemented the Free Health Care Initiative (FHCI) for pregnant women, lactating mothers and children under age five to address high mortality and morbidity. This study examined participant satisfaction with health services before and after the FHCI implementation. Methods: This was a retrospective study that assessed healthcare satisfaction in rural Sierra Leone after the implementation of the FHCI. Participants were interviewed using a structured satisfaction questionnaire about the FHCI. Conclusions: Results find a positive, statistically significant difference in participant satisfaction with ambulance services after the implementation of the FHCI compared to the level of satisfaction prior to the FHCI. Although results indicate a very slight increase in overall satisfaction with healthcare services, and a slight decrease in satisfaction with drug availability after the implementation of FHCI, the results are not statistically significant. Findings also indicate that participants attending emergency obstetric care (EmOC) facilities were less satisfied with the services provided than those attending the non-EmOC facility or hospital.