‘Never let a crisis go to waste’: post-Ebola agenda-setting for health system strengthening in Guinea

Abstract

IntroductionGuinea is a country with a critical deficit and maldistribution of healthcare workers along with a high risk of epidemics' occurrence. However, actors in the health sector have missed opportunities for more than a decade to attract political attention. This article aims to explain why this situation exists and what were the roles of actors in the agenda-setting process of the post-Ebola health system strengthening programme. It also assesses threats and opportunities for this programme's sustainability.MethodsWe used Kingdon’s agenda-setting methodological framework to explain why actors promptly focused on the health sector reform after the Ebola outbreak. We conducted a qualitative explanatory study using a literature review and key informant interviews.ResultsWe found that, in the problem stream, the Ebola epidemic caused considerable fear among national as well as international actors, a social crisis and an economic system failure. This social crisis was entertained by communities’ suspicion of an 'Ebola-business'. In response to these problems, policy actors identified three sets of solutions: the temporary external funds generated by the Ebola response; the availability of experienced health workers in the Ebola control team; and the overproduction of health graduates in the labour market. We also found that the politics agenda was dominated by two major factors: the global health security agenda and the political and financial interests of national policy actors. Although the opening of the policy window has improved human resources, finance and logistics, and infrastructures pillars of the health system, it, however, disproportionally focuses on epidemic preparedness and response. and neglects patients’ financial affordability of essential health services.ConclusionDomestic policy entrepreneurs must realise that agenda-setting of health issues in the Guinean context strongly depends on the construction of the problem definition and how this is influenced by international actors.

Retention of Healthcare Workers One Year After Recruitment and Deployment in Rural Setting: an Experience Post-Ebola in Five Health Districts in Guinea

“…[5] Nonetheless, in the aftermath of the Ebola outbreak, efforts were made by the Guinean government, with the support of development cooperation initiatives, to strengthen the health system, and to make it resilient to future epidemics, through improved availability and distribution of HCWs. [4,7] Initiatives that resulted from this reform allowed the recruitment of over 5,000 HCWs between 2016 and 2017 and their majority deployment (95%) in rural health districts in April 2017. [4] In addition, and as recommended by the WHO, exceptional regulatory and nancial measures were applied to this new staff in order to increase their motivation for working in their assigned areas and also limit their turnover.…”

“…[4,7] Initiatives that resulted from this reform allowed the recruitment of over 5,000 HCWs between 2016 and 2017 and their majority deployment (95%) in rural health districts in April 2017. [4] In addition, and as recommended by the WHO, exceptional regulatory and nancial measures were applied to this new staff in order to increase their motivation for working in their assigned areas and also limit their turnover. [4] These measures include the signing of a ve-year contract for rural practice; a 40% increase in their salary; the delocalization, at district level, of the salary payment; the creation of a directorate of human resources for health within the Ministry of Health (MoH) with more responsibilities in this staff supervision.…”

“…[3,4] Furthermore, international actors have established a budgetary-support to the post-Ebola HSS reform, but conditional to the achievement of a minimum retention rate of 80% of HCWs in their assigned locations. [4] Therefore, the main objective of this study is to document the implementation process of this post-Ebola HCW retention policy at local 2. To analyse barriers and enablers of the retention of public healthcare workers in rural areas; 3.…”

Evolution of the COVID-19 pandemic over six weeks in four French-speaking countries in West Africa

“…The COVID-19 pandemic further weakens health systems in Africa. Without speci c treatment or a vaccine, the health services which suffer from huge gaps in human, material, and nancial resources are struggling to adequately care for the infected people [8].…”

Healthcare Transformation in the Post-Coronavirus Pandemic Era

“…The COVID-19 pandemic has become a reality check for many aspects of healthcare systems, especially regarding their overall readiness. Public health surveillance programs and available infrastructures were shown as not consistently optimal ( 5 – 7 ). Additionally, healthcare systems appeared unable to absorb and manage sudden and persistent pressures on their workload especially in the settings of acute care.…”