Dr. Alemu, Photo Credit: WHO

 

MLI is conducting interviews with development partners to get their views on country ownership and leadership in MLI countries. This entry is from Dr. Wondimagegnehu Alemu, WHO country representative in Sierra Leone.

Have you seen greater evidence of country ownership/leadership in Sierra Leone, and if so, in what way?

I would say in the last 7-8 years, leadership has slowly been returning to the government and the Ministry of Health and Sanitation (MoHS). They’re exercising their leadership role and making critical decisions on their own. When developing the National Health Sector Strategy Plan (NSSP), 2010-2015, the MoHS led the process with technical support from the World Health Organization. Development partners and other implementing partners including NGOs are supporting the implementation of the strategic plan.

An example: During development of the NHSSP, the WHO helped the government to initiate the process and ensured the necessary facilitation continued while the MoHS developed the plan with the participation of health partners through a series of consultation meetings. There were multiple working groups, each chaired by the relevant MoHS official and focused on different pillars of the health system. All the important meetings in the process of development were chaired by the Chief Medical Officer and the Hon. Minister of Health and Sanitation, so it gave a lot of weight to the level of participation. The President of the Republic himself also officially launched the NHSSP.

The free health service also was dictated by the President himself and the MoHS. It was supported by bilaterals, multilaterals, private agencies and other concerned parties. The leadership of the Ministry was fully involved. So, do we feel that we have now every capacity in that area? No. But there’s still more than there was. Health partners are supporting the MoHS wherever they need extra capacity to ensure that they can deliver the services.

What was the situation like in Sierra Leone before the government starting establishing more leadership?

Implementation was fragmented to the extent that development partners were supporting NGOs in implementing the health care services of the country instead of the government. In fact, more than 200 NGOs were operating at one time in some areas. That was during the recovery phase [from the civil war]. And slowly, slowly, the leadership came back to the Ministry. Now, every month there is a health implementer partnership meeting, chaired by the Chief Medical Officer and, during that meeting, all partners share information. There is also a quarterly meeting of the National Health Coordinating Committee, chaired by the Minister of Health and Sanitation. Members include relevant ministries of other sectors, representatives of bilateral and multilateral agencies, and health-oriented civil groups.

Has anything changed since Sierra Leone became an IHP+ country?

Sierra Leone became part of the International Health Partnership in May 2010. There is no change yet, however. The government and development partners are now working on a Memorandum of Understanding (MoU), commonly known as a country health compact, with the goal of completing it by the 50^th anniversary of independence, April 27^th, 2011.

With IHP+, partners are expected to align their priorities to that of the government and also obliged to harmonize their plan to the NHSSP. Every year the MoHS will develop an annual operations plan in consultation with health partners, monitor implementation and review performance. The MoU will also create a conducive working arrangement for partners to support the implementation of the annual plan, which was approved through the coordination mechanism. Our aim is to ensure that the government finalizes the MoU and that everybody is happy about that arrangement and abides by it so that resources are directed to the government as budget support. Everybody will monitor implementation.

Partners would like to have very transparent management whereby the government can account for all the resources development partners are putting into the government system. Development partners need to have confidence that the system is very accountable.

Is the Ministry of Health relating to donors in a different way?

Overall, the top leadership of the Ministry is strengthening the relationship with health development partners. The challenge is there are only a handful of donor partners in the country. So what the country needs are additional new donor partners to join the country and help them implement within the framework of the IHP+. Overall, the direction is good, but we have to see how much will be implemented into practice.

What is the most important thing development partners can do to strengthen Ministry of Health ownership?

I think it’s recognition, recognizing that the government is the leader of the whole process and that development partners are there to support government, guided by national priorities and policies. Both development partners and the country are responsible, for example, for achieving the Millennium Development Goals (MDGs). Achieving the MDGs depends on good leadership and commitment on the part of the government and whether the development partners are making available resources that will help the country achieve the MDGs.

The other important thing is commitment. One of the things I have noticed is the flow of resources is not predictable. The government is not always sure what resources are available for the MoHS to implement planned activities. So maybe partners have to be more transparent and make sure they make known the level of resources that will bring desired results to the health sector. Continuing to support activities that are already in place, including the free health service, is also important. We need to have predictable funds to procure the medicines and other supplies and distribute them to health facilities on time.

Supporting the building of health systems to deliver health interventions is also critical. As a post conflict country, Sierra Leone needs to do a lot in building its systems, including health facility infrastructure, human resources for health production and retention, and procurement and supply chain management.

Ultimately, it all depends on how well health development partners position themselves to better dialogue with the government to ensure the necessary resources for the provision of affordable and equitable health services to all citizens without undermining the leadership of the government.

 

Additional Blogs in the Dialogue with Development Partners Series:

Anne Peniston, USAID/Nepal