Postwar reconstruction in Sierra Leone was accompanied by an ambitious donor-promoted decentralization programme aimed at making delivery of the country's failing social services more efficient. A decade after the 'decentralization' of health services, this article examines systemic failures that have resulted in de-concentration rather than devolution of the health system. It identifies four factors that have contributed to a dysfunctional decentralized provision of primary health care. First, is an inconsistent political and legal framework that blurs and distorts delineations of authority between central and subnational government institutions. This leads to three further challenges that interact to create an ineffective public health sector: the central government is resistant to devolution, partly due to a culture of accumulation; local-level interventions are uncoordinated; and there is limited accountability for frontline health workers. As a result, citizens' health needs are unmet. Sierra Leone is plagued by some of the worst maternal and child mortality rates in the world, and faced the most intractable outbreak of the 2014-2015 Ebola epidemic. Drawing on participant observation and interview data, this article suggests that building a resilient decentralised primary healthcare system will largely depend on the willingness of the centre to meaningfully devolve power and resources to subnational governments, and establish a mutual accountability mechanism in which 'actors' at all levels are held accountable.
The nature of chieftaincy has been identified as one of the causes of Sierra Leone's civil conflict, but the institution has largely retained its pre-war privileges and conflict triggers. Using evidence from ethnographic research, this piece investigates the tensions between chiefs and NGOs in alternative dispute resolution mechanisms. Chiefs perceive NGOs as undercutting their powers and livelihood, resulting in strains. Given the entrenched nature of chieftaincy, current attempts by NGOs to ensure better judicial outcomes for the poor will produce limited success, if the prevailing atmosphere of mistrust persists. A trustful and congenial relationship between chiefs and NGOs is proposed.
The politics of decentralization reforms in Sierra Leone are both unpredictable and instructive. This article based on fieldwork and secondary data, analyses party politics within the context of decentralization, arguing that the imperatives of postwar decentralization are not necessarily embedded in technical considerations, but in processes of political compromise and accommodation. Decentralization has helped facilitate the re-emergence of the old political order, in that the country's main political parties have secured a consensus through which they have reconfigured the postwar state. This framing is useful in understanding the political economy in which fragility and political compromise continue to co-exist.
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