Co-developing pathways for community health system resilience through participatory action research in Sierra Leone

Résumé fourni par la source

Health system resilience has become critical in addressing shocks such as emerging and re-emerging disease outbreaks, natural disasters, and conflicts. Collaboration among diverse stakeholders, including health systems and communities, is hypothesized to enhance resilience. However, evidence from low- and middle-income countries, particularly fragile and shock-prone settings like Sierra Leone, remains limited. This study documents the initiation of a participatory action research (PAR) project in Sierra Leone aimed at building health system resilience through collaboration with health and multisectoral stakeholders in the districts of Moyamba and Kailahun. The study employed PAR principles and methodologies, including document reviews, participatory power mapping, and workshops. These methods were used to identify leverage points and co-develop an action agenda for health system resilience. The participatory mapping phase revealed key leaders and their power dynamics within the community and health system. Formal leaders, health sector actors, and religious leaders emerged as the most powerful and trusted figures. Systemic barriers to community leader engagement in public health emergencies were identified, including political affiliations, traditional beliefs, reduced direct community engagement (attributed to low community health worker numbers), and patriarchal gender norms. The co-created action agendas prioritized community engagement, early warning systems and the use of by-laws. The study underscores the potential of community leaders as catalysts for resilient health systems in Sierra Leone. Inclusivity, accountability, and trust are essential for engaging community leaders in health system decision-making processes. Addressing systemic challenges through such engagement can foster health system and community resilience in emergencies.

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