Implementation of the reproductive, maternal, newborn, child and adolescent health policy in Sierra Leone: dynamics, challenges, and opportunities faced by policy implementers at the national and sub-national levels


Partners: COMAHS, Sierra Leone, Queen Margaret University, UK and London School of Hygiene and Tropical Medicine, UK


Sierra Leone, like other low- and middle-income countries (LMICs), has instituted several health reforms to ensure that the national health system is robust enough to provide quality health care that is accessible and affordable to the Sierra Leonean population. Reproductive, maternal, child, and adolescent health (RMNCAH) is a national priority, however, progress is slow.


This research aims to employ an ethnographic methodology to generate data from multiple perspectives and contexts to understand the power dynamics and contestations in the implementation of the RMNCAH policy in Sierra Leone and contribute to the use of ethnographic methodology in policy implementation research in LMICs. Active stakeholder engagement is crucial to this research and will form the basis for the research findings to generate effective policy recommendations to improve the implementation of future polices in Sierra Leone and other fragile states.


Research questions

  1. Who are the major actors, stakeholders and interest groups involved in the implementation of the RMNCAH policy, how are they coordinated and how does this impact on the policy implementation process and policy outcomes? This study will also investigate resource availability for the effective implementation and the impact on policy implementation and outcomes.
  2. What structures are available for the successful implementation of the RMNCAH policy and how do these structures incentivise actors’ behaviours at the national and district health management team levels?
  3. What are the implementation gaps impeding the implementation of the RMNCAH policy? The study will also explore the government’s priorities in the implementation of the RMHCAH policies and programs.
  4. What are the everyday negotiations, contestations, interactions, and actor behaviours that make up implementation in practice at the national and sub-national levels?


Outputs from this project


Image: Mother and baby at Makeni Regional Hospital, Sierra Leone. H6 Partners & Abbie Trayler-Smith via Flickr [opens new tab]



"ReBUILD for Resilience brings together partners to share experiences, to discuss our contexts, and to create an appropriate model that helps build resilience in health systems across the country and beyond"

Sushil Baral, HERD International