Category: Sierra Leone
Health systems resilience in fragile and shock-prone settings through the prism of gender, equity and justice: implications for research, policy and practice
ReBUILD for Resilience paper on using a conceptual resilience framework to identify actions promoting gender, equity and justice in fragile and shock-prone settings
Supporting community health workers in fragile settings from a gender perspective: a qualitative study
Community health workers are vital in fragile and conflict-affected settings. This paper looks at their gendered experiences in Sierra Leone, Liberia and DRC
Report on the Sierra Leone strand of the study ‘The gendered experience of close-to-community providers in fragile & shock-prone settings: implications for policy & practice during & post COVID-19’
This brief explores the roles of close-to-community health care providers in Sierra Leone and their gendered experiences during the COVID-19 pandemic
A summary of the Maintains programme (2018-21) and its outputs: research supporting social services’ adaptation to external shocks
The comparative agility of the community health worker cadre in fragile & conflict-affected contexts
Presentation on ReBUILD’s research into the agility of community health worker cadres in four fragile settings during Covid-19
How should community health workers in fragile contexts be supported: qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo
Paper presents evidence from three fragile settings – Sierra Leone, Liberia and Democratic Republic of Congo – on managing community health workers and recommends best approaches to support them
Summary of ReBUILD’s cross cutting and synthesis non peer-reviewed outputs, eg videos, briefs, infographics etc
Political economy approaches to explore PBF’s adoption, adaption and implementation in fragile settings
Presentation given by Maria Bertone at the International Health Economics Association congress in Basel July 2019
Establishing a responsive & equitable health workforce post-conflict & post-crisis: lessons from ReBUILD research
Human resources for health is the most expensive, complex and critical health system pillar, and one with more political ramifications – it is crucial to learn lessons about how to rebuild it effectively post-conflict. This brief highlights some of the main findings on HRH and recommendations from ReBUILD’s research.
(How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo
Results-Based Financing has proliferated in health sectors of low and middle income countries, especially fragile and conflict-affected ones, and has been presented as a way of reforming and strengthening strategic purchasing. However, few studies have empirically examined how RBF impacts on health care purchasing in these settings. This article examines the effects of several RBF programmes on health care purchasing functions
the past decade.
Les systèmes de santé après un conflit – éléments probants en faveur de meilleures politiques et pratiques
Ces documents de synthèse décrivent les thèmes principaux issus des recherches de ReBUILD, ainsi qu’un aperçu du programme et de son large éventail de projets de recherche jusqu’en 2016.
Three presentations on performance-based financing filmed during the 2018 Fifth Global Symposium on Health Systems Research
A summary document giving an overview of the projects and research themes which have made up ReBUILD’s work.
Details of all outputs from ReBUILD’s work on gender and post-conflict health systems.
Presentations recorded during the session ‘Leaving No One Behind – how can evidence-based approaches support progress towards UHC and global health goals during conflict and protracted crises?’, part of the Fifth Global Symposium on Health Systems Research in October 2018 in Liverpool.
Dr Maria Bertone speaks about performance-based financing for healthcare in Sierra Leone
This brief outlines the meaning of health system research capacity, the particular needs for such research capacity in crisis-affected settings, and key lessons for future policy, building on the broad experience of the ReBUILD Consortium and tacit knowledge of the ReBUILD partnership as well as wider literature
This policy brief reviews key dimensions of sustainability and their relevance for crisis-affected settings, then presents lessons for encouraging sustainability in these settings.
This ReBUILD brief discusses the associations between health systems and state-building and the empirical evidence in this area.
The political economy of crisis-affected settings: what does it mean for investments in health systems?
This brief reviews key elements in the response to crises from a political economy perspective, evidence on the opportunities and challenges presented by crises, and lessons in how to best utilise those opportunities to promote investment in health systems.
How do different types of provider affect access to effective and affordable healthcare during and after crises?
This brief summarises the key characteristics of the different types of providers and the health services they offer, and discusses their involvement in health crises and possible interventions that can increase access to effective and affordable healthcare during and after crises.
This policy brief reviews the meaning of universal health coverage (UHC) and summarises lessons for achieving UHC in crisis-affected settings.
This policy brief highlights the ways in which health systems reinforce the marginalisation of some social groups, and then summarises the effects of crises on inclusiveness and the interventions that can protect and enhance equity for those marginalised.
Institutions for strong and equitable health systems after conflict and crisis – lessons from ReBUILD research
This brief outlines the findings from ReBUILD’s phase 1 research informing the theme of institutions in post-conflict health systems.
Establishing a responsive and equitable health workforce post-conflict and post-crisis – lessons from ReBUILD research
This brief outlines the findings from ReBUILD’s phase 1 research on health workers in post-conflict settings.
This brief outlines the findings from ReBUILD’s phase 1 research on health financing policies in post-conflict settings and how these have affected access to health care for the most vulnerable populations.
The ReBUILD programme and emerging themes for health systems strengthening in post-conflict and post-crisis settings
This brief outlines the main themes on health systems in post-conflict and post-crisis settings which came from the first phase of the ReBUILD programme, and the range of research projects which gave rise to these findings and themes.
Les systèmes de santé pendant et après une crise : éléments probants en faveur de meilleures politiques et pratiques
Cette série de documents de synthèse, fruit des recherches menées par ReBUILD, aborde un nombre de questions clés concernant le renforcement des systèmes de santé dans les contextes affectés par un conflit ou une crise.
Summary of ReBUILD’s cross cutting and synthesis non peer-reviewed outputs, eg videos, briefs, infographics etc
ReBUILD briefing papers addressing issues around gender, vulnerable groups and intersectionality in health systems in a range of countries
This series of ReBUILD briefing papers addresses some key questions related to health systems strengthening in settings affected by conflict or crisis.
Webinar – Performance-based financing in fragile and conflict-affected settings: from research to practice
Recording of a webinar on the impact of PBF research on practice in fragile and conflict-affected settings
Performance-based financing as a way to build strategic purchasing in fragile and conflict affected settings: potential and pitfalls
Presentation given by Sophie Witter at a Satellite Session on “Payment for Performance, how, why, where and what?”, at the Fifth Global Symposium on Health Systems Research in Liverpool, on 9th October 2018.
Presentation on the changing health care needs of communities and health system responses in fragile settings by Tim Martineau at the Fifth Global Symposium on Health Systems Research in Liverpool, October 2018.
A ReBUILD paper on the development of performance-based financing for healthcare in Sierra Leone
Presentation (French language) on the state of knowledge on health systems in fragile contexts, given by Professor Sophie WItter at an International Workshop at the Institute of Tropical Medicine in Antwerp on 16th October 2018.
The bumpy trajectory of performance-based financing in Sierra Leone: agency, structure and frames shaping the policy process
Presentation given by Maria Paula Bertone at the 5th Global Symposium on Health Systems Reseach in Liverpool on Wednesday 10th October 2018.
Presentation given by Sophie Witter at a satellite session on “Health financing in fragile & conflict affected settings – controversies and innovations” at the 5th Global Symposium on Health Systems Research in Liverpool, on 8th October 2018.
This booklet presents the findings of a photovoice project into health systems and Community Health Workers in Sierra Leone
This booklet presents the findings of a photovoice project into how gender infuences the service provided by Community Health Workers in Sierra Leone
Gender and community health worker programmes in fragile and conflict-affected settings. Findings from Sierra Leone, the Democratic Republic of Congo and Liberia
Based on findings from ReBUILD’s research project on community health workers in fragile and conflict-affected settings, this brief provides recommendations and guidance for practitioners and policy makers on the ways their workforce may be affected by gender norms, and actions to address them.
This brief presents key messages from and a summary of ReBUILD’s research into performance-based financing
Haja Wurie of ReBUILD and College of Medicine and Allied Health Sciences talks on community health workers in Sierra Leone. More on ReBUILD’s work on community health workers here.
Video of Maria Bertone of ReBUILD speaking on the consortium’s work on performance-based financing in fragile and post-conflict states
Are health systems interventions gender blind? Examining health system reconstruction in conflict affected states
This ReBUILD paper examines if and how rebuilding health systems affected gender equity in four post-conflict contexts.
Supporting community health workers in fragile settings: evidence from Sierra Leone, Liberia and Democratic Republic of Congo
Poster presented at the Fifth Global Symposium on Health Systems Research in Liverpool in October 2018 on supporting community health workers in fragile settings
This summary of ReBUILD’s research projects from both the original phase and the short extension phase of the programme. It includes links to further information on the projects and their outputs.
Presentation given by Professor Sophie Witter on 17th May 2018 for the American University of Beirut Global Health Institute’s Webinar series: “Global Health and Conflict”. This webinar theme: Health Systems in Situations of Fragility.
A paper from ReBUILD exploring the gendered experiences of health workers in fragile and post-conflict states
Changes in catastrophic health expenditure in post-conflict Sierra Leone: an Oaxaca-blinder decomposition analysis
A paper from ReBUILD examining how households’ exposure to financial risks through seeking healthcare evolved in post-conflict Sierra Leone.
Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study
A paper from ReBUILD’s study on health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’ s health system.
Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems
Literature review from ReBUILD by on how context affects performance-based health financing in fragile and conflict-affected settings.
What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal
ReBUILD paper examines health systems research that explored and evaluated health worker performance during crises in Sierra Leone & Nepal
Why do people become health workers? Analysis from life histories in four post‐conflict and post‐crisis countries
Paper from ReBUILD’s health worker incentives research looking at motivation to join the profession in Uganda, Sierra Leone, Cambodia & Zimbabwe.
How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia
Paper draws together lessons from ReBUILD’s research on health worker incentives in northern Uganda, Sierra Leone, Zimbabwe and Cambodia.
Health financing in conflict-affected and post-conflict settings: Resources from ReBUILD’s work
This paper draws on ReBUILD’s research to understand key issues inhibiting health systems strengthening in fragile settings
Incentives for health workers to stay in post and in rural areas: findings from four conflict- and crisis-affected countries
ReBUILD report presents a cross-cutting analysis into health worker incentives in post-crisis northern Uganda, Sierra Leone, Cambodia & Zimbabwe
Health systems research in fragile and conflict affected states: a qualitative study of associated challenges
This 2017 ReBUILD paper seeks an understanding of the challenges of conducting health systems research in fragile and conflict-affected settings
This 2015 ReBUILD paper argues that more attention should be focused on addressing gender inequalities and inequities in conflict-affected states
Experiences of using life histories with health workers in post-conflict and crisis settings: methodological reflections
This paper examines the ReBUILD programme’s experience of using life histories to explore health system trajectories coming out of conflict through the eyes of health workers. The paper shows how life histories with health staff can be a very powerful tool, particularly in contexts where routine data sources are absent or weak, and where health workers constitute a marginalized community.
Evolution of policies on human resources for health: opportunities and constraints in four post-conflict and post-crisis settings
This article draws on ReBUILD’s research on human resources for health across four post-conflict settings, shedding light on the patterns and drivers of post-conflict policy-making. It explores whether the post-conflict period offers increased chances for the opening of ‘windows for opportunity’ for change and reform and the potential to reset health systems.
This article, published in Human Resources for Health, reports the findings from ReBUILD’s qualitative work in Sierra Leone on health worker incentives.
In June 2016 ReBUILD submitted evidence to the High Level Commission on Health Employment and Economic Growth, based on the findings and experience on human resources for health from the research team, especially related to fragile and conflict affected settings. You can access the submitted evidence here.
These briefs outline the main themes which have come from ReBUILD’s research, as well as an overview of the programme, its research projects, and how the themes developed from these.
Presentation made by Sophie Witter at DFID lunchtime seminar 19th January 2016
Learning from the experiences of health workers in conflict-affected Cambodia to improve motivation and retention: analysis of life histories
This 2016 ReBUILD working paper looks at the evolution of health worker incentives in Cambodia, Sierra Leone, Uganda and Zimbabwe
How to promote a resilient health workforce in conflict affected settings – insights from four countries
Combined presentations from a ReBUILD panel session at the 4th Global Symposium on Health Systems Research in Vancouver, Canada, on 18th November 2016
Poster from ReBUILD’s cross-country study on people’s health needs and health seeking behaviour before, during and after conflict. This poster was presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada
What do health workers do, and why? A study of the activities performed by primary healthcare workers in Sierra Leone
Poster from ReBUILD/LSHTM affiliate study on Health Workers’ Remuneration, Incentives and Accountability in Sierra Leone, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada
Outputs from the project Health Workers’ Remuneration, Incentives and Accountability in Sierra Leone
This page lists all outputs from the project Health Workers’ Remuneration, Incentives and Accountability in Sierra Leone
Poster from ReBUILD’s health financing study in Sierra Leone, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada
Becoming more effective actors for evidence-based health systems policy and practice; Experiences of research, research uptake and capacity-building from the ReBUILD research programme consortium
Poster on ReBUILD’s experiences of research uptake and capacity building at national and international levels
Poster from ReBUILD’s study on health worker experiences of the Ebola outbreak in Sierra Leone, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada
Resources from ReBUILD’s work on health worker incentives in Sierra Leone, and on health worker experiences during the Ebola outbreak
Details of all outputs from ReBUILD’s work on health worker incentives and remuneration in Sierra Leone, and on health worker experiences during the Ebola outbreak.
Resources from ReBUILD’s work on health worker incentives and deployment in post-conflict and post-crisis settings
This document includes details of all outputs from ReBUILD’s work on human resources for health in post-conflict and post-crisis settings.
A working paper on the ReBUILD study ‘Fighting a battle: Ebola, health workers and the health system in Sierra Leone’
A ReBUILD consortium report from the Sierra Leone Human Resources for Health Summit 2016
Performance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone
The study investigates the absolute and relative contribution of performance-based financing (PBF) to health workers’ income and explores their views on PBF bonuses, in comparison to and interaction with other incomes. The study confirms the complex and interrelated nature of health workers’ remuneration and that the different financial incentives cannot be examined independently from one. It also shows that the way PBF schemes are implemented has an impact on health worker motivation.
Can donors really build institutions? Reflections on recent health sector experiences in Sierra Leone
Presentation made by Dr Sophie Witter at World Bank Fragility Forum panel session on “Can donors really build institutions?”. The presentation was based on experiences and research findings from ReBUILD and others from Sierra Leone’s health sector. The 2016 World Bank Fragility Forum was held in Washington on 1st-3rd March 2016. You can access and… Read more
Investigating health workers remuneration in Sierra Leone – preliminary results and reflections on methods
Presentation given by Maria Paola Bertone at the 3rd Conference of the African Health Economics and Policy Association (11-13 March, 2014, Nairobi).
Presentation given by Tim Martineau at the Human Resources for Health Summit in Freetown, Sierra Leone, 2nd June 2016.
Combined presentations given at the launch of the Building Back Better website and resources on gender in post conflict health systems; 20th October 2015 in Liverpool
Complete presentations given by ReBUILD team at a stakeholder meeting on “Evidence for supporting a health workforce for all in Sierra Leone”, held on 28th January 2016 in Freetown
Presentation given by Joanna Raven on ReBUILD’s work on health systems in post-conflict states, at a Workshop on Rebuilding Health in Yemen after Conflict, 4th June 2016 in Liverpool
Presentation given in June 2016 by Sophie Witter on the ReBUILD programme’s findings on Human Resources for Health in Post-Conflict settings.
Human Resources in Fragile and Conflict-Affected settings – cross sectoral issues between health and education
A 2016 overview presentation on human resources in health and education in fragile and conflict-affected settings
Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone’s free health care initiative
This paper reports the findings of a study evaluating the impact of Sierra Leone’s 2010 Free Health Care Initiative (FHCI). It uses two nationally representative surveys to identify the impact of the policy on utilisation of maternal care services by pregnant women and recent mothers as well as the impact on curative health care services and out-of-pocket payments for consultation and prescription in children under the age of 5 years.
This 2016 ReBUILD paper investigates the formal and informal payments available to health workers in Sierra Leone
Increasing access to health services in remote and rural areas through improved retention of health workers: evidence from Sierra Leone
This 2014 poster describes a study on the effectiveness of incentive packages in attracting and retaining health workers in Sierra Leone
The challenges and opportunities of conducting ethical and trustworthy qualitative research in health systems in post-conflict and fragile contexts: Reflections from a learning community
ReBUILD poster presented at the Third Global Symposium on Health Systems Research in Cape Town 2014: A qualitative study exploring how to strengthen policy and practice related to health financing and human resource management in post conflict and fragile contexts
Incentives to improve health workers’ retention and motivation: implementation challenges and informal practices at district level. The role of DHMTs and NGOs
This policy brief describes findings and gives recommendations from ReBUILD research on the actual implementation of policies on human resources for health at local level in Sierra Leone. The brief includes reflections on the challenges of translating knowledge not only into policy but also into effective practice. You can download the brief here.
Exploring the remuneration of primary healthcare workers: findings on incomes and income use strategies in Sierra Leone. What lessons can be learnt to design effective financial incentives?
This policy brief describes ReBUILD research to explore all of the financial incentives that make up health workers’ remuneration in Sierra Leone
Presentation on health financing in post-conflict settings given by Barbara McPake at Nossal Institute of Global Health in July 2015
Research on health worker policies, incentives and retention in post-conflict countries: an overview of ReBUILD work
Presentations from ‘Evolution of policy and incentives for human resources for health post-conflict: learning from different contexts’ 2015
This brief outlines ReBUILD’s research on health worker incentives in Sierra Leone, and gives recommendations for the post-Ebola recovery strategy, based on the research findings, focusing on the strand for in-creasing a skilled workforce, especially in under-served areas.
ReBUILD, together with the REACHOUT and COUNTDOWN RPC, produced this joint submission of evidence in response to a call from the UK All Party Parliamentary Group on Africa’s Inquiry on community-led health systems and the Ebola outbreak.
In this 2015 video Haja Wuried of the ReBUILD consortium shared her insights on post-Ebola health system reconstruction in Sierra Leone
Ebola in the context of conflict affected states and health systems: case studies of Northern Uganda and Sierra Leone
Ebola seems to be a particular risk in conflict affected settings. This paper compares the experience of Northern Uganda and Sierra Leone in the emergence and management of Ebola outbreaks in 2000-1 and in 2014-15 respectively, and how elements of these conflict affected societies affected the disease outbreak and the response.
This document is a summary of the protocol for ReBUILD’s research on understanding health worker incentives in post-conflict settings. It details the approach used for this research across all four of the study countries. You can download the document here.
Financial incentives for human resources for health: What do we know? What do we do? The case of Sierra Leone
Abstract of an oral presentation given by Maria Paola Bertone at the “Health Services Research: Evidence-Based Practice” conference in July 2014
Performance-Based Financing in the context of the ‘complex remuneration’ of Health Workers – Findings from a mixed-methods study in rural Sierra Leone
Presentation by ReBUILD Affiliate researcher Maria Paola Bertone given at the International Health Economics Association Congress in Milan 15th July 2015
An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone
This 2015 ReBUILD paper focuses on health worker incentives and payments in Sierra Leone and presents an exploration of district-level implementation processes
Report of a Sierra Leone stakeholder mapping exercise from 2012 to understand the actors who influence policy and practices in human resources for health
This narrative literature review is an output of collaborative work between ReBUILD and the Stockholm International Peace Research Institute (SIPRI) working group on gender, to explore the opportunities and challenges for building gender responsive health systems in post conflict contexts.
A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002–2012
This paper draws on ReBUILD’s research to look at the development of policies on human resources for health (HRH) in Sierra Leone over the decade after the conflict (2002–2012).
A 2015 RBUILD report on the need to reach and maintain incentive environments for health workers to support access to equitable health services
ReBUILD Sierra Leone—August 2013 Newsletter Read the full newsletter
A 2011 short introduction to ReBUILD’s research programme to support health system development in post-conflict Sierra Leone
A window of opportunity for reform? The case of policy on human resources for health in Sierra Leone after the conflict (2002-2012)
The study in this 2014 ReBUILD brief looks at the development of policies on human resources for health in Sierra Leone over the post-conflict decade
Drawing on ReBUILD’s research on health worker experiences and incentives in Sierra Leone, this briefing paper was produced to inform key actors involved in maintaining basic health services during the 2014-15 Ebola outbreak.
This briefing note provides a summary update of ReBUILD’s progress across the whole range of its research themes and focus countries, as of February 2015.
Building gender responsive health systems in post-conflict contexts: Opportunities and challenges Presentation given at a Global Health, Policy and Practice session 7 March 2014 Read the full presentation
A 2014 ReBUILD presentation from Haja Wurie on her first-hand experience of how Ebola has impacted on the health system in Sierra Leone.
2015 presentation entitled ‘Current work of ReBUILD: Research for Building pro-poor health systems in the aftermath of conflict’
Presentation entitled ‘ReBUILD: Gender and health theme’ by Sally Theobald of ReBUILD Consortium
ReBUILD presentation from 2013 on health systems in conflict-affected states
A REBUILD consortium Country Situation Analysis for Sierra Leone from 2011
In this paper published in Health Policy and Planning, ReBUILD researchers Sophie Witter, Haja Wurie and Maria Bertone explore the effects and implications for health staff of Sierra Leone’s introduction in 2010 of the Free Health Care Initiative (FHCI).
This 2014 ReBUILD report pulls together findings relating to the Free Health Care Initiative (FHCI), as part of ReBUILD’s wider research on the evolution of incentives for health workers in post-conflict Sierra Leone.
A 2014 ReBUILD report on staffing the public health sector in Sierra Leone, 2005‐11: findings from routine data analysis
This ReBUILD document review summarises the human resources for health context in Sierra Leone in 2013 and post-conflict policies introduced
A ReBUILD consortium report on the he development of humna resources for health policy in Sierra Leone, 2002-2012
This 2014 ReBUILD study in Sierra Leone used a life history approach to explore health workers’ experiences over time