Paper short abstract:

Policy-making is undoubtedly a political process, but implementation is no less so. This presentation looks at the effects on policy implementation and local governance of the political economy dynamics between actors at district level in Sierra Leone, before and after Ebola.

Paper long abstract:

Although often overlooked, political factors and dynamics between actors at local level are key to shape policy implementation. This presentation aims to explore the political economy of implementation processes at local level, before and after a crisis. It builds on a previous study (Bertone Witter, 2015) which focused the implementation of Human Resources for Health (HRH) policies in three districts of Sierra Leone, by using a political economy framework to analyze the dynamic interactions between structure (context, historical legacies, institutions) and agency (actors, agendas, power relations). It shows that the official policies are re-shaped both by implementation challenges and by informal practices emerging locally as the result of the district-level dynamics between District Health Management Teams (DHMTs) and NGOs, with the aim of ensuring a better fit between the actors' agendas and HRH incentives. Importantly, the negotiations which shape such practices are characterized by a substantial asymmetry of power between DHMTs and NGOs.

These challenges became even more relevant during the Ebola outbreak, as new actors entered the stage at local level, with urgent priorities and limited time and interest to align and coordinate. Now, in the aftermath of the crisis, how to limit the discrepancy between central-level policies and local practices and ensure the effectiveness of policy implementation in the long-term? The presentation will also give a preliminary look at the current situation in Sierra Leone and reflect on approaches to intervention at local level which would address the implementation gap, support local governance and ownership, and benefit communities and patients.