title: A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002-2012.
abstract: BACKGROUND
  It is recognized that decisions taken in the early recovery period may affect the development of health systems. Additionally, some suggest that the immediate post-conflict period may allow for the opening of a political 'window of opportunity' for reform. For these reasons, it is useful to reflect on the policy space that exists in this period, by what it is shaped, how decisions are made, and what are their long-term implications. Examining the policy trajectory and its determinants can be helpful to explore the specific features of the post-conflict policy-making environment. With this aim, the study looks at the development of policies on human resources for health (HRH) in Sierra Leone over the decade after the conflict (2002-2012).
  
  
  METHODS
  Multiple sources were used to collect qualitative data on the period between 2002 and 2012: a stakeholder mapping workshop, a document review and a series of key informant interviews. The analysis draws from political economy and policy analysis tools, focusing on the drivers of reform, the processes, the contextual features, and the actors and agendas.
  
  
  RESULTS
  Our findings identify three stages of policy-making. At first characterized by political uncertainty, incremental policies and stop-gap measures, the context substantially changed in 2009. The launch of the Free Health Care Initiative provided to be an instrumental event and catalyst for health system, and HRH, reform. However, after the launch of the initiative, the pace of HRH decision-making again slowed down.
  
  
  CONCLUSIONS
  OUR STUDY IDENTIFIES THE KEY DRIVERS OF HRH POLICY TRAJECTORY IN SIERRA LEONE: (i) the political situation, at first uncertain and later on more defined; (ii) the availability of funding and the stances of agencies providing such funds; (iii) the sense of need for radical change - which is perhaps the only element related to the post-conflict setting. It also emerges that a 'windows of opportunity' for reform did not open in the immediate post-conflict, but rather 8 years later when the Free Health Care Initiative was announced, thus making it difficult to link it directly to the features of the post-conflict policy-making environment.
authors: ReBUILD Consortium & Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors: Maria Paola
authors: MP
authors: Bertone
authors: ReBUILD Consortium, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
authors: Mohamed
authors: M
authors: Samai
authors: ReBUILD Consortium, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
authors: Joseph
authors: J
authors: Edem-Hotah
authors: ReBUILD Consortium, Reader, IIHD, Queen Margaret University, Edinburgh, UK.
authors: Sophie
authors: S
authors: Witter
keywords: Human resources for health; Policy analysis; Post-conflict; Sierra Leone; Window of opportunity