Research for stronger health systems during and after crisis

A new article has been published following the evaluation of Sierra Leone’s Free Health Care Initiative, led by ReBUILD’s Sophie Witter.

Wednesday, 17 Jan 2018

Launched in April 2010, the Sierra Leone’s Free Health Care Initiative (FHCI) took an ambitious approach to reducing financial barriers by introducing health systems strengthening across all pillars (Governance, Communications, M&E, Drugs and Medical Supplies, Infrastructure, Health Workforce, and Financing).

This article presents the findings of a theory-based evaluation of the FHCI, using mixed methods. Whilst finding that there had been weaknesses in implementation in a number of core areas, the authors conclude that the FHCI was cost-effective and was one important factor contributing to improvements in coverage and equity of coverage of essential services for mothers and children. They suggest that even—or perhaps especially—in a weak health system, a reform-like fee removal, if tackled in a systematic way, can bring about important health system gains that benefit vulnerable groups in particular.


Photo credit: Robert Yates / Department for International Development