Paper short abstract:

The PRP Delivery Unit (DU) was established to help rebuilt Sierra Leone after the Ebola crisis. This talk highlights how this new mode of governance impacted on the primary health care management in a district and how it contributed to broader concerns about sovereign power and responsibility.

Paper long abstract:

Over the past decade, DUs proved to be a somewhat successful new global mode of bureaucratic management, in that they helped political leaders to stay focused on the delivery of key policy priorities. Since their initiation in 2001, some twenty-five countries have in-cooperated DUs in their governance structure. Sierra Leone has introduced a DU shortly after the end of the Ebola crisis in order to help achieve the PRPs thirteen Key Result Areas, which span across seven priority sectors: education, energy, governance, health, private sector development, social protection and water. In this talk, I highlight how the PRP DU added another layer of governance to an already pluralistic, dispersed and diversified national and district health governance landscape. I specifically focus on how a PRP district delivery team (PDDT) was perceived to be a recentralisation agent as it limited district actors' sovereign power and responsibility. Drawing on fourteen months of ethnographic research, I provide a bottom-up account on how district stakeholders contested this new mode of governance as they felt that their managerial and sovereign right to deliver public goods and to manage and intervene in the district's health affairs was undermined. This, in turn, brought about tensions on who had the legitimate sovereign responsibility to deliver healthcare to the citizens in this district. This research has vast reaching implications on future health system strengthening efforts, as it highlights important strengths and shortcomings of the Sierra Leonean PRP DU and how these played out at a district level, but also on the community level.