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Health Service Delivery in Sierra Leone- A Role for Justice and Accountability?

Event Description

Sierra Leone has made progress in promoting human development since the end of its 11-year civil war; however, the country is still striving to improve health care delivery.  Confronted with maternal and under-five mortality rates among the highest in the world, the Government has made significant investments in the health sector.  One such program is the Free Health Care Initiative (FHCI).  Launched in April 2010, the FHCI aims to improve health by offering free health care services to pregnant and lactating women and children less than five years of age.

Programs such as the FHCI require extensive ‘supply-side’ inputs – such as increased health staff, essential drugs, and rehabilitated clinics.  Yet experience from other countries suggests that social accountability (or ‘demand-side’) programs can effectively complement supply-side efforts to improve health outcomes.1  The Bank, Government, and civil society groups in Sierra Leone have all embraced a role for social accountability in improving health care delivery.

The Bank is supporting these efforts by testing and evaluating several social accountability approaches to improving health service delivery including community-clinic monitoring and legal empowerment.  With financing from the Decentralized Services Delivery Project (I and II), the Government is currently supporting a randomized controlled trial on the impact of joint community-clinic monitoring on health outcomes.1  Through the use of scorecards showing their clinic’s performance, community monitoring enables community members and clinic staff to draft a joint action plan to improve health and then monitor one another’s performance.

With support from the World Bank’s Nordic Trust Fund and in partnership with the legal empowerment organization Namati, the Justice for the Poor Program (J4P) is also exploring how Legal Empowerment tools, such as trained community paralegals, can tackle challenges in health care delivery and complement social accountability efforts in the health sector.  Community paralegals (lay persons trained in the law and operating in approximately a third of Sierra Leone’s chiefdoms) may be able to help citizens navigate administrative accountability channels to address larger, systemic breakdowns in service delivery.

This brown bag lunch will present the design and reflections on implementation from the work underway in Sierra Leone and discuss strategies to improve accountability between health service providers and citizens.

This event is open to the general public. Attendees from outside the World Bank Group will need to register their interest in attending by 5 p.m. the day before the event by emailing Lakshmi Mathew at lmathew@worldbank.org. The email should specify the proposed attendee’s full name, organization or street address, email address and a phone number at which the attendee may be contacted.  External participants should bring photo ID and enter through the World Bank’s visitor entrance on 18th street.

(1) See, e.g., M. Bjorkman and J. Svensson, “Power to the people: Evidence from a randomized experiment on community-based monitoring in Uganda,” Quarterly Journal of Economics 124/2 (2009).

Date: Thursday, August 2, 2012

Time: 12:30 – 2:00 p.m.

Venue: MC C1-200, with VC connections to Accra and Freetown


Christina Biebesheimer, Chief Counsel of the Justice Reform Practice Group


Margaux Hall, Justice for the Poor Program in Sierra Leone


Qaiser M. Khan, Lead Economist and Sector Leader for Human Development in Ghana, Liberia and

Sierra Leone


Mirey Ovadiya, Senior Social Protection Specialist, Social Protection Anchor

More information on the World Bank’s Justice for the Poor program: 





July 27, 2012 | Namati