A Promise Kept: How Sierra Leone's President Introduced Free Health Care in One of the Poorest Nations on Earth, 2009-2010

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Abstract 

When Ernest Bai Koroma assumed the presidency of Sierra Leone in 2007, he promised to run his government as efficiently as a private business. A few years earlier, a brutal 11-year civil war had ended, leaving an estimated 50,000 dead and an additional two million displaced. The effects of the war gutted the government’s capacity to deliver basic services. Koroma launched an ambitious agenda that targeted key areas for improvement including energy, agriculture, infrastructure and health. In 2009, he scored a win with the completion of the Bumbuna hydroelectric dam that brought power to the capital, Freetown. At the same time, the president faced mounting pressure to reduce maternal and child death rates, which were the highest in the world. In November, he announced an initiative to provide free health care for pregnant women, lactating mothers and children under five years of age, and set the launch date for April 2010, only six months away. Working with the country’s chief medical officer, Dr. Kisito Daoh, he shuffled key staff at the health ministry, created committees that brought ministries, donors and non-governmental organizations together to move actions forward, and developed systems for monitoring progress. Strong support from the center of government proved critical to enabling the project to launch on schedule. Initial data showed an increase in utilization rates at health centers and a decline in child death rates. 

Michael Scharff drafted this case study on the basis of interviews conducted in Freetown, Sierra Leone and London, U.K., in September and October 2011. Case published February 2012. See related cases, “Turning on the Lights in Freetown, Sierra Leone: Completing the Bumbuna Hydroelectric Plant, 2008-2009” and “Delivering on a Presidential Agenda: Sierra Leone’s Strategy and Policy Unit, 2010-2011.”
Keywords 
infrastructure
project management
Sierra Leone
accountability
training
child health
maternal mortality
health care
procurement
strategic management
strategic planning
public support
institution-building
managing expectations
Capacity building
poverty
recruitment
international donors
ghost workers
salaries
center of government
Focus Area(s): 
Building a Reform Team and Staff
Centers of Government
Critical Tasks: 
Adaptive management
Donor coordination
Preparation of policy papers and choices
Strategic planning
Core Challenge: 
Principal-agent problem (delegation)
Country of Reform: 
Sierra Leone
Type: 
Case Studies
Author: 
Michael Scharff