Navigating power in policy adoption: The political economy of noncommunicable diseases in Sierra Leone

Le résumé fourni par la source

Non-communicable diseases (NCDs) represent a rising health burden globally, yet low- and middle-income countries (LMICs), particularly fragile states, face persistent barriers to NCD prevention and control policy adoption and implementation. This qualitative case study examines the factors influencing NCD policy adoption in Sierra Leone, a country that, in recent years, has focused on tackling these conditions. Drawing on 20 key informant interviews and 39 policy documents and media analysis, the study highlights the interplay of global health norms, commercial determinants, and local capacities. Findings reveal how international frameworks like WHO’s ‘best buys’ provide essential guidance but often fail to accommodate local socio-political realities. The analysis underscores how multisectoral coalitions, power dynamics, and commercial interests shape outcomes of policy adoption, while chronic underfunding and donor-driven priorities further complicate governance. Recommendations emphasize the importance of context-sensitive strategies that integrate local knowledge systems, strengthen leadership, and embed implementation research. Ultimately, fostering adaptive, accountable, and well-resourced health systems, supported by global solidarity and coordinated governance reforms, is essential to achieving sustainable NCD responses, particularly in an era marked by fractured multilateralism and weakened collective action, where strengthening local capacities and political commitment becomes even more critical. • Political economy analysis reveals power dynamics shaping noncommunicable disease (NCD) policy adoption in Sierra Leone. • Global norms influence local NCD policies but risk neglecting contextual realities. • Multisectoral coalitions and civil society advocacy have been crucial for policy progress in Sierra Leone. • Industry interference and trade agreements act as barriers to NCD policy adoption. • Context-sensitive governance reforms and local leadership are essential for sustainability.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.