Research for stronger health systems during and after crisis

Health service delivery in fragile and conflict-affected settings: challenges and lessons

 

Date: October 10th 2018

 

About the session

This session comprises several oral presentations. Maria Bertone, of the Institute for Global Health and Development, Queen Margaret University, UK and ReBUILD, will present The bumpy trajectory of performance-based financing in Sierra Leone: unpacking the role of external actors, and Bandeth Ros of Cambodia Development Resource Institute and ReBUILD is presenting 'Impacts of conflict on access to healthcare: missing generation and disability in Cambodia'.

 

The bumpy trajectory of performance-based financing in Sierra Leone: unpacking the role of external actors

This presentation will explore the political dynamics of the introduction and implementation of performance-based financing (PBF) in Sierra Leone from 2010 to 2017. The study draws on a document review and 25 key informant interviews and presents a political economy analysis looking at key elements of agency (actions, relations and agendas), structure (context, history, key events and timing) and frames (ideas, meanings and narratives).


The analysis describes the process of negotiation and re-negotiation of PBF in Sierra Leone, highlighting the role of both internal and external players. It shows that external actors have an important role in driving the debate by making use of actual frames (eg by defining the timing and pace of the discussions) and metaphorical frames (ie how PBF is interpreted, defined and understood). This is facilitated by the lack of capacity and resources in the fragile setting. The presentation will illustrate these processes and discuss key policy implications.