Governance of Health Systems in Fragile and Conflict-Affected States
Fragmentation of health system governance in Sierra Leone, influenced by historical events. Challenges include structural limitations, funding dependencies, and external donor engagement. Examples such as performance-based financing and community health worker programs highlight sustainability issues due to policy fragmentation and donor reliance.
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Presentation Transcript
Who governs health systems in FCAS? Lessons learnt on effective factoring of political dynamics to achieve UHC Dr Haja Ramatulai Wurie College of Medicine and Allied Health Sciences, University of Sierra Leone
Fragmentation of the health system governance in Sierra Leone Fragmentation of the health system governance in Sierra Leone Context fragmentation shaped (and sometimes exacerbated) by historical events and responses Fragmentation has manifested itself across structures, funding and external donor engagement Structures Limited focus within the health sector is focused on addressing the structural and technical challenges within the MoHS itself (HSSP 2015) Policy/plan implementation National ownership vs TA (adequate exit strategy) Funding National investment: significant commitments to health backed up with investments (10.8% of total government expenditure on health) International lending dependency culture External donor Prolonged external dependence, donor misalignment, proliferation of partner and donor involvement (vertical programmes) Improved coordination of plans, activities and resources among GoSL and its partners (NHSSP 2017 2021) Effective coordination of many key players - SLAs
Examples Examples Performance based financing Community Health Worker Programme Integration and sustainability challenges due to policy and planning fragmentation, vertical funding and implementation Heavily dependent on donors and partners for technical, operational, and financial support Financial sustainability of the CHW program PHC vs HRH
