After years of neglect of its healthsystem, Sierra Leone has had, starting in 1993, remarkablesuccesses in health reform. As there have been few cases ofhealth reform in Africa, a study was undertaken to examinethe experience. Through interviews, surveys, focus groups,mass meetings, task forces, workshops and other methods,thousands of Sierra Leoneans have been involved in settingthe reform agenda. The health reform effort has beenremarkably transparent. By creating their own nationalhealth action plan, the Sierra Leoneans were able toestablish their own agenda with donors, on their own terms.The department won the Heroes Day Award in 1994 inrecognition of improved performance in the Sierra Leoneancivil service. This type of public accolade helps to build apositive environment for reform.
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