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Paper short abstract

The paper examines how transformations of political values both shape and are reflected in health reform policies in post-war Sierra Leone. It traces policy trajectories and everyday care to show how citizenship, gender, and justice are negotiated within a shifting global and local political order.

Paper long abstract

The paper presents the first results of an ongoing ethnographic research project that examines the relationship between political values, governance patterns, and health system reform in post-war Sierra Leone, with a particular focus on recent efforts to introduce universal health coverage (UHC) alongside the national social health insurance scheme (SLESHI). Although both initiatives have featured prominently in policy documents since 2018, UHC in Sierra Leone remains largely aspirational.

The paper investigates how shifting local and global political agendas shape health reforms, and how these reforms (or their spectral manifestations) are experienced by those most affected—especially low-income women and girls whose livelihoods depend on the informal economy. Tracing policy trajectories from central institutions to frontline health facilities, the research brings together the perspectives of policymakers, health workers, and service users: women of modest income.

By situating everyday encounters with care within broader political processes, the project explores how health becomes a key arena in which questions of responsibility, citizenship, and social justice are negotiated. In doing so, it also analyses how changes in health governance reflect the reconfiguration of state–society relations from post-war democracy-building under massive international intervention to the current moment of global power shifts and democratic crisis.

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