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Health reform is a widely used term across the world. However, little work has been done to identify its processes, dynamics and key factors for success, especially in the developing world. The paper describes the elements of health reform in one African nation, Sierra Leone, where progress is being made despite poor economic and security conditions. Within the framework of a National Health Action Plan, Sierra Leone is seeking to overhaul its health system and to focus it on populations with the greatest need. This paper systematically discusses the context, content and processes of health reform in Sierra Leone. In reviewing actions taken and proposed in reforming a package of services, the organization of service provision, and the financing of the health sector, the role of key stakeholders are highlighted. From this case study, six critical success factors are identified: 1) strong leadership; 2) broadening the arena of stakeholders; 3) managing the donors; 4) moving toward a task culture; 5) clear prioritization; and 6) the celebration of success. The paper concludes with an assessment of future prospects for health reform in Sierra Leone.

Publisher: World Bank

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