Leadership plays a crucial role in healthcare facilities to ensure proper health service delivery. This research was undertaken to assess leadership in the performance of government-owned hospitals in Sierra Leone, with a focus on Makeni Government Hospital. A stratified and purposeful sampling strategy was employed in the investigation. For this study, we selected employees from Makeni Government Hospital to participate as respondents. A sample of 100 respondents were carefully chosen from the hospital. The study collected data from both primary and secondary sources. Interviews and a structured questionnaire were used to gather the primary data. We conducted both quantitative and qualitative data analysis. We used descriptive statistics, regression, and Pearson correlation to analyze the quantitative data and presented the findings in tables, pie charts, and bar charts. This study found that the hospital leadership possesses the necessary skills and competencies, with a predominant transformational leadership style that effectively contributes to proper health service delivery. The results also reveal a weak positive correlation between leadership styles, health service delivery, health workers commitment to work, and hospital performance. These findings suggest that an effective and efficient leadership style can improve hospital performance.