Building Capacity for Resilient Health Systems - Lessons Learned from Sierra Leone, Guinea, and Liberia in the Time of Ebola

Author(s): Hart L, Street D, Kulatilaka H

Year: 2017

Abstract:

In the wake of the Ebola outbreak, the United States Agency for International Development (USAID)-funded MEASURE Evaluation implemented health systems strengthening interventions, all with a strong capacity building (CB) component, in Liberia, Sierra Leone, and Guinea. All three interventions consisted of an assessment followed by strategic planning. Two technical advisors from MEASURE Evaluation were embedded in these countries’ health ministries for three months to implement the assessment and strategic planning. This effort was followed by virtual technical assistance (TA).

The uniform approach used across the three countries presents a unique opportunity to compare and contrast the experience of CB in different countries. This comparison is of particular interest, because a MEASURE Evaluation-wide capacity building policy that promotes this same process—an assessment followed by action planning—was recently enacted for all CB efforts.

The purpose of this report is to provide insight into strategies for CB for resilient health systems, by documenting and comparing the experience of capacity assessment followed by strategic planning in Guinea, Sierra Leone, and Liberia. Information was gathered from key informant interviews with MEASURE Evaluation staff and supplemented by an extensive desk review of MEASURE Evaluation’s internal documentation.

Lessons learned consisted of insights into the importance of assessing and planning for CB, the value of stakeholder engagement within that process, ideas for planning for the transition of responsibilities from MEASURE Evaluation to the ministry of health, the need for realistic scopes of work, and the value of implementing such an intervention during a time of crisis. Implementing an assessment of the health information system—including both system and staff capacity—in each country allowed the rest of the process to be tailored to that country’s needs. This allowed for each country to plan for systematic CB going forward.

By engaging stakeholders throughout the process, these strategic plans are more likely to find champions in the countries and to be implemented after MEASURE Evaluation’s activities end. Different transition experiences in each country imparted valuable knowledge about various aspects of these handoffs. These experiences were part of a larger lesson involving intervention in a time of crisis. Crisis situations present urgent staffing challenges and role changes are needed to address emergent issues quickly. This type of instability can make any intervention difficult to implement, but is especially challenging for CB efforts that rely on the presence of specific people within a health system in order to move forward.

These lessons provide important information to guide future CB efforts. The importance of systematic CB—including assessment and planning—further validates best practices at MEASURE Evaluation and elsewhere. Given the global focus on human resources for health—of which CB is an important part—and health systems strengthening, we hope that these insights will also be of use outside of the project.