The mapping of our existing knowledge and knowledge gaps to produce a synthesis was conducted to enable identification of priority research questions for the health system in Sierra Leone.
This was achieved by making a comprehensive inventory of (research) literature and documents on health systems in Sierra Leone and reviewing relevant documents to identify existing gaps in knowledge and information regarding health systems in Sierra Leone. Verification of the existing knowledge and additions to that knowledge was provided through semi-structured interviews and a 2-day workshop (in April 2009) with key health system stakeholders such as the Ministry of Health and Sanitation (MoHS) Directors and Managers of programs, senior staff of NGOs, United Nations (UN) agencies including the World Health Organisation (WHO), UN Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), and bilateral/multilateral donors (Irish Aid, United Kingdom Department for International Development (DFID) etc.).
In general research in/ around the health system in Sierra Leone appears to be donor driven, with many (partial) health sector or district health system reviews and surveys. Detailed research with more specific research questions and applied research studying pilot / new interventions is not very common. Research capacity small, fragmented and not well coordinated.
Human Resources for Health in Sierra Leone with respect to numbers, type of staff and their training is extensively documented; mostly as (part of) human resources and/or health sector reviews. More detailed research or documentation regarding HRH is mostly absent and research areas to be considered could include negative and positive contributions of TBAs and related community health workers to maternal and child health; push and pull factors for middle and higher level health staffs, possibilities within the exiting structures (pay roll not under direct control of MoHS) to practice effective human resource management at the various levels, use of performance based salaries/incentives etc. etc. Although some NGOs did research on equity and access to health especially regarding free service versus cost recovery, there is no mainstream research ongoing in these areas. More detailed areas within this theme like gender and cultural access are mostly uncovered. Governance, although reasonable well described in many review documents, has not been a topic of research, but more part of reviews and needs assessments. Specific aspects of governance could be relevant as priority research questions for later stages of CHRAIC research.
