Health workers and fee exemption schemes. ReBUILD’s new paper on how Sierra Leone’s Free Health Care Initiative has affected health workers.

In a new paper published in Health Policy and Planning, ReBUILD researchers Sophie Witter, Haja Wurie and Maria Bertone explore the effects and implications for health staff of Sierra Leone’s introduction in 2010 of the Free Health Care Initiative (FHCI).

Addressing a previous gap in the literature, their analysis shows how a high-profile policy fee-exemption policy, supported by financial and technical resources can galvanise real systemic changes. They show how the FHCI led to reforms which had a major effect on health workers in Sierra Leone, and that motivation has improved, but that there remain tensions between different health worker cadres as well as a demand for a more consistent package of incentives, particularly in rural areas.

Key messages that come from their analysis include how a broad, well supported health financing change like the FHCI can be a catalyst for broader health system reforms, and that reforms in human resources for health are at the core of making such a change function effectively. However, key challenges remain, intensified by the devastation of the Ebola epidemic, especially in ensuring that changes support good quality of care and an effective rural service, and in sustaining the momentum for reform which remains dependent on external resources.

This paper is open access and can be accessed via this link.