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‘Never let a crisis go to waste’: post-Ebola agenda-setting for health system strengthening in Guinea
  1. Delphin Kolie1,
  2. Alexandre Delamou1,2,
  3. Remco van de Pas3,
  4. Nafissatou Dioubate1,
  5. Patrice Bouedouno1,
  6. Abdoul Habib Beavogui1,
  7. Abdoulaye Kaba4,
  8. Abdoulaye Misside Diallo4,
  9. Willem Van De Put3,
  10. Wim Van Damme3
  1. 1Research, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
  2. 2Department of Public Health, University of Conakry, Conakry, Guinea
  3. 3Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
  4. 4Bureau de Stratégie et de Développement, Ministère de la Santé, Conakry, Guinea
  1. Correspondence to Dr Delphin Kolie; dkolie{at}


Introduction Guinea is a country with a critical deficit and maldistribution of healthcare workers along with a high risk of epidemics' occurrence. However, actors in the health sector have missed opportunities for more than a decade to attract political attention. This article aims to explain why this situation exists and what were the roles of actors in the agenda-setting process of the post-Ebola health system strengthening programme. It also assesses threats and opportunities for this programme's sustainability.

Methods We used Kingdon’s agenda-setting methodological framework to explain why actors promptly focused on the health sector reform after the Ebola outbreak. We conducted a qualitative explanatory study using a literature review and key informant interviews.

Results We found that, in the problem stream, the Ebola epidemic caused considerable fear among national as well as international actors, a social crisis and an economic system failure. This social crisis was entertained by communities’ suspicion of an 'Ebola-business'. In response to these problems, policy actors identified three sets of solutions: the temporary external funds generated by the Ebola response; the availability of experienced health workers in the Ebola control team; and the overproduction of health graduates in the labour market. We also found that the politics agenda was dominated by two major factors: the global health security agenda and the political and financial interests of national policy actors. Although the opening of the policy window has improved human resources, finance and logistics, and infrastructures pillars of the health system, it, however, disproportionally focuses on epidemic preparedness and response. and neglects patients’ financial affordability of essential health services.

Conclusion Domestic policy entrepreneurs must realise that agenda-setting of health issues in the Guinean context strongly depends on the construction of the problem definition and how this is influenced by international actors.

  • agenda-setting
  • Ebola outbreak
  • health system strengthening
  • health workforce
  • global health security
  • Guinea

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  • Handling editor Seye Abimbola

  • Contributors DK, AD, RvdP and WVD conceived and designed the study and received feedback from AHB, AK and AMD. DK, AD, RvdP, ND and PB were involved in data acquisition, analysis and interpretation, and revising it critically for important intellectual content. DK drafted the manuscript with inputs from AD, RvdP, WVDP, AHB and WVD. All the authors have given final approval for the version to be published.

  • Funding This study is financed as part of a Fourth Framework Agreement (FA-IV) programme (2017–2022) between the Belgian Directorate of Development Cooperation and government of Guinea pertaining to scientific capacity building.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information.