By Bruce Siegel, David Peters, Sheku G. Kamara
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Additional info for Health reform in Africa: lessons from Sierre Leone, Parts 63-347
This paper systematically discusses the context, content and processes of health reform in Sierra Leone. In reviewing actions taken and proposed in reforming a package of services, the organization of service provision, and the financing of the health sector, the role of key stakeholders are highlighted. From this case study, six critical success factors are identified: (1) strong leadership; (2) broadening the arena of stakeholders; (3) managing the donors; (4) moving toward a task culture; (5) clear prioritization; and (6) the celebration of success.
This country was selected because its reform effort is well documented and appears to be bearing its first successes. Sierra Leone is a low-income nation which appears to be making great strides in health against daunting odds, and we are in a unique position to study just how and why this is happening. In this paper, Walt and Gilson's framework for health policy analysis 3 is used as a basis for analyzing health reforms in Sierra Leone (see Figure 1). According to this framework, the execution of sector reform is dependent on the context in which health reform is introduced and executed, the content of the reform itself (the design of what is actually reformed), and process by which reforms are developed, implemented, and evaluated, and the interaction of stakeholders who are affected by, and influence the context, content, and process of sector reform.
Those rankings were then modified based on the cost-effectiveness, acceptability, feasibility and equity of the relevant strategies, to generate a more final list of health priorities. During this process, several site visits were made to three provincial cities to conduct "town meetings" and focus groups involving over 100 male and female chiefs. Later, in 1994, a beneficiary assessment was conducted which used other qualitative methods to elicit opinions and perceptions around health priorities in three rural and urban sites.