Chronicity of disruptive project rhythms: The projectification of the ‘post-Ebola' health system rebuilding in Sierra Leone

Abstract

Global health development projects are inherently governed by bounded, temporal and linear time frames: the initiation, implementation and ending of time-limited interventions. This projectification of global health programmes has wide-reaching consequences as global health projects, often unsustainable and produces both new life possibilities and uncertain futures. This article highlights the temporal effects of the global health agenda on the primary health system rebuilding efforts in Sierra Leone. Attention is paid to how the projectification of public health programmes affected the primary healthcare management in a district in the southern region of Sierra Leone. Throughout this article, I develop the theoretical concept of chronicity of disruptive project rhythms where local public healthcare actors encounter project disruptions on a continuum of chronic lack. I base this concept on Manderson and Smith-Morris’s definition of chronicity of illness experience, which is marked by punctuated episodes of acute sickness, where chronic patients are temporally transmuted into acute patients, while at the same time continuing to suffer from their ongoing chronic ailments. Drawing on 14 months of ethnographic research, I show how a district health management team (DHMT) contested the bounded time frames of public health funding; how waiting time for funding impacted the operation of the DHMT and, by extension, the district health system as a whole and how DHMT employees and other actors within the health system employed time-tricking strategies to resist this project time.

Beyond Lassa Fever: Systemic and structural barriers to disease detection and response in Sierra Leone

“…As a result of that outbreak, which highlighted inadequate surveillance and response systems [ 35 ], much of the focus of donor-sponsored health system rebuilding in the aftermath of the outbreak has been on improvements to surveillance and other International Health Regulations (IHR)-mandated health system components, with health security increasingly dominating the policy discourse in Sierra Leone [ 36 ]. While the epidemic drew attention to the health system fragmentation that had contributed to the Ebola epidemic, recovery efforts that prioritised a donor-led health security agenda have contributed to a further fragmentation of the system [ 36 – 39 ].…”

Public Sector Projectification – A Systematic Review of the Literature

“…Projects require timely output production of research (Torka, 2018), and Virtova and Vostal (2021) suggest that workers apply a strategy of "time stretching," where the boundaries of projects are stretched in time. Hubmann (2021) argues for "time-tricking" in the same manner. Virtova and Vostal (2021) investigate project work strategies in fusion research and argue increased projectification may reduce one's presence in the workplace.…”

Four images of projectification: an integrative review

“…Studies within this image have also studied projectification in a wide variety of contexts. Examples include the role of projectification when it comes to ways to combat epidemics (Glasdam et al, 2015;Meinert and Whyte, 2014), projectification of public policies (Bailey and Hodgson, 2019;Jensen et al, 2017;Mukhtar-Landgren and Fred, 2019; € Ojehag-Pettersson, 2017), the projectified method of distributing funds for research (Baur et al, 2018;Fowler et al, 2015;Brajdi c Vukovi c et al, 2020) and international aid (Baker, 2014;Hubmann, 2021). However, there are also new and emerging research areas in which the causes and effects of projectification processes are considered, such as ecology (Hodge and Adams, 2016), entrepreneurship (Auschra et al, 2019) and sustainable development (Cerne and Jansson, 2019;Cwikła et al, 2020).…”