Health sector fragmentation: three examples from Sierra Leone.
External development assistance
Health sector fragmentation
Health system strengthening
Sierra Leone
Journal
Globalization and health
ISSN: 1744-8603
Titre abrégé: Global Health
Pays: England
ID NLM: 101245734
Informations de publication
Date de publication:
22 01 2019
22 01 2019
Historique:
received:
16
09
2018
accepted:
14
12
2018
entrez:
24
1
2019
pubmed:
24
1
2019
medline:
5
2
2019
Statut:
epublish
Résumé
Fragmentation across governance structures, funding, and external actor engagement in Sierra Leone continues to challenge the efficiency and coherence of health sector activities and impedes sustained health system strengthening. Three examples are discussed to highlight the extent, causes, and impacts of health sector fragmentation in Sierra Leone: the community health worker programme, national medical supply chain, and service level agreements. In these examples we discuss factors contributing to fragmentation, the impact on efficiency of systems and sustainability of interventions, and persistent barriers to achieving sustainable improvements in health system performance. Prolonged external dependence and a proliferation of partner and donor involvement tending towards vertical programming and funding have contributed to this fragmentation. Alignment of policy and planning initiatives, investment in proactive (to reduce need for reactive) policy and plan development, strengthened partnerships, and strengthened governance and accountability mechanisms offer opportunities for greater health sector integration.
Sections du résumé
BACKGROUND
Fragmentation across governance structures, funding, and external actor engagement in Sierra Leone continues to challenge the efficiency and coherence of health sector activities and impedes sustained health system strengthening. Three examples are discussed to highlight the extent, causes, and impacts of health sector fragmentation in Sierra Leone: the community health worker programme, national medical supply chain, and service level agreements.
RESULTS
In these examples we discuss factors contributing to fragmentation, the impact on efficiency of systems and sustainability of interventions, and persistent barriers to achieving sustainable improvements in health system performance. Prolonged external dependence and a proliferation of partner and donor involvement tending towards vertical programming and funding have contributed to this fragmentation.
CONCLUSION
Alignment of policy and planning initiatives, investment in proactive (to reduce need for reactive) policy and plan development, strengthened partnerships, and strengthened governance and accountability mechanisms offer opportunities for greater health sector integration.
Identifiants
pubmed: 30670026
doi: 10.1186/s12992-018-0447-5
pii: 10.1186/s12992-018-0447-5
pmc: PMC6341573
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
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