A window of opportunity for reform? The case of policy on human resources for health in Sierra Leone after the conflict (2002-2012)
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This 2014 ReBUILD briefing paper is based on a published paper A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, from the Conflict and Health Series, Filling the void: Health systems in fragile and conflict affected states.
The study described in the brief looks at the development of policies on human resources for health (HRH) in Sierra Leone over the decade after the conflict (2002–2012). The study identifies key drivers of HRH policy trajectory in Sierra Leone: (i) the political situation, at first uncertain and later on more defined; (ii) the availability of funding and the stances of agencies providing such funds; (iii) the sense of need for radical change – which is perhaps the only element related to the post-conflict setting. It also emerges that a ‘windows of opportunity’ for reform did not open in the immediate post-conflict, but rather 8 years later when the Free Health Care Initiative was announced, thus making it difficult to link it directly to the features of the post-conflict policy-making environment.
One of the challenges when a conflict is over is the balance between emergency aid to save lives and a longer-term approach based on rebuilding the health system. Some researchers believe that the decisions taken shortly after a conflict can influence how the health system will develop and that a political “window of opportunity” for reform exists at this time. To test these two concepts and to understand how reform takes place, it is helpful to analyse how, when and why policy is made after conflict. In order to do this, the ReBUILD Consortium focused on the factors shaping policy on human resources for health in Sierra Leone after the war had ended in 2002. The findings are published in an article which begins by setting the context of the health system in Sierra Leone before the war; explains the methods used to collect information for the study and the difficulties encountered, and looks at how policy on health workers was made from 2002 to 2012. Three stages in policy-making are identified and discussed in detail. The article concludes that decisions taken early on after the war in Sierra Leone did have an impact on the development of human resources for health policy and ultimately the health system. However, the window of opportunity for reform did not open immediately after the end of the conflict but eight years afterwards when a key initiative came into force which introduced free health care at the point of delivery, for mothers and children. This event – propelled by increased political will from high-ranking government officials as well as international pressure and support – sparked off major changes throughout the health system.
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