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Using evidence to strengthen accountability for health financing in Sierra Leone

This article is part of an Evidence for Action-MamaYe series on accountability published in the International Journal of Gynecology and Obstetrics (IJGO). It documents lessons from a nationwide health budget advocacy election campaign in Sierra Leone.

In 2012, the government of Sierra Leone cut the national budget allocation to the health sector. E4A-MamaYe worked with Save the Children, Budget Advocacy Network, the Freetown Water, Sanitation and Hygiene Consortium, and other civil society members of the Budget Advocacy Working Group, on a nationwide health budget advocacy campaign. The campaign called for increased allocation, efficiency, and transparency of spending for mothers and babies in Sierra Leone. It coincided with the 2012 general elections, aiming to strengthen accountability for health budgets by engaging citizens around these issues immediately before the election.

As part of the campaign, E4A-MamaYe produced district health budget tracking scorecards. The scorecards presented Ministry of Finance data on the allocation and disbursement of health funds in each district. For example, in Bo in 2011, the Council was reported to have transferred 26 770 million Leone (around US $6.08 million based on 2011 currency conversion rates); however, the DHMT reported receiving only 514 million Leone, leaving approximately 98% unaccounted for. The data were communicated using simple, non-technical language so that citizens could understand the key messages and take action.

A total of 5600 scorecards were shared at district electoral forums attended by political candidates, community members, and health activists. The electoral forums were recorded and aired by community radio stations, so those unable to attend could still access the information. Activities across the wider campaign, led by Save the Children, enabled activists and citizens to use the evidence for advocacy and accountability.

Since the election, the proportion of the total government budget allocated to health increased from 7.4% in 2012 to 11.2% in 2014. However, transforming politicians’ commitments and pledges into implementation has been challenging, confirming that accountability is a long-term process.

To access the full article for free, click here.

To access more articles in E4A-MamaYe’s series on accountability in the IJGO, click here.

Lebbie, S. A., Le Voir, R., Tom-Kargbo, J., Yilla, M. D., Kamara, A. B., & Nam, S. L. (2016). Using evidence to strengthen accountability for health financing in Sierra Leone. International Journal of Gynecology and Obstetrics, 135(3),380-384.
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