Is WHO ready to improve its country work?

Nordström, Anders

doi:10.1016/s0140-6736(17)33360-3

Cited by 4 publications

(2 citation statements)

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“…By the end of 2017, no staff was in charge solely of health system strengthening or health financing. The absence of health system strengthening specialisation is not unique to Sierra Leone and similar to many WHO country offices [ 46 ]. Finally, respondents stressed that donors seem to have a myopic agenda focused on ‘their’ projects, which results in a fragmented landscape of projects only partially coordinated at national level and very disjointed at sub-national level [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

The bumpy trajectory of performance-based financing for healthcare in Sierra Leone: agency, structure and frames shaping the policy process

et al. 2018

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BackgroundAs performance-based financing (PBF) has been increasingly implemented in low-income countries, a growing literature has developed, assessing its effectiveness and, more recently, focussing on the political dynamics of PBF introduction and implementation. This study contributes to the latter body of literature by exploring decision-making processes on PBF in Sierra Leone during the 2010–2017 period. Sierra Leone presents an interesting case because of the ‘start-stop-start’ trajectory of PBF.MethodsThe qualitative case study is based on a document review and 25 key informant interviews with national stakeholders and international actors. Documents and interviews were analysed based on a political economy framework focusing on actors and structure, but also making use of concepts drawn from interpretive policy analysis to look at frames.ResultsOur analysis describes the process of negotiation and re-negotiation of PBF in Sierra Leone, highlighting the role of different players, both internal and external, their ideas, capacity and power relations, and the shifting narratives around PBF. It is shown that external actors driving the debate make use of ‘frames’, both actual (i.e., defining the timing and pace of the discussions, the funding available, etc.) and metaphorical (i.e., how PBF is interpreted, defined and understood) to fit in and influence the debate. This is facilitated by the lack of capacity and resources in the fragile setting. Other strategies, such as ‘venue shopping’ are employed, though they may add to fragmentation in the volatile context.ConclusionsThe retrospective view of the study has an analytical advantage, but findings are also relevant to guide practice. Although power relations and rent-seeking issues are difficult to overcome in resource and capacity-constrained settings, more attention could be paid to other elements. In particular, adopting shared frames to ensure a common and inclusive understanding of technical concepts such as PBF may be useful to ensure the political sustainability of reforms. Also, the ‘actual frames’ which define negotiation and implementation should remain flexible, allowing for disrupting events (e.g., the Ebola epidemic in Sierra Leone) as well as for time to develop national capacity and ownership in order to ensure longer-term political support and better health system integration.

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Section: Resultsmentioning

confidence: 99%

The bumpy trajectory of performance-based financing for healthcare in Sierra Leone: agency, structure and frames shaping the policy process

et al. 2018

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“…COVID-19, with its limitations on travel, has shown that a strong physical presence within countries is more important than ever. 4 Institutions dependent on fly-in, fly-out missions need to rethink their operations. At the same time, COVID-19 has also shown how much of global health travel, especially for generic stakeholder meetings, can be avoided, with benefits for staff, countries, and the planet.…”

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confidence: 99%