<p>Multi-drug resistant Tuberculosis (MDR-TB) is a complex infectious disease and is a threat to global health. Globally it is estimated that about 630,000 tuberculosis patients have multi-drug tuberculosis and require treatment. Sierra Leone is among the world’s 30 most affected countries accounting for 87% of the global infection rate. The Tuberculosis surveillance system is part of the general framework of Integrated Disease Surveillance and Response and we, therefore, evaluate the system to determine its performance, assess key attributes and make appropriate recommendations to improve the system.</p>