This paper examine how informal network in Sierra Leone helped the official effort to fight against Ebola Virus Disease (EVD) to be accepted by local people in urban settings. The bureaucratic system of the Sierra Leone is far from coherent and efficient. Some scholars argue that the politics of Sierra Leone is operated through informal human networks (Christensen 2013; Utas [ed.] 2012). Such government faced with the Ebola crisis during 2014 and 2015. During the crisis, the government established a response system coordinating relevant ministries being assisted by international organizations and NGOs. International organizations and NGOs constructed treatment centers. Medical doctors were dispatched from overseas, and the government of Sierra Leone coordinate various agencies. This "formal response" was essential part of combating EVD. However, the formal system was not accepted by local people. People did not believe even the existence of EVD in the initial stage, which hinders the government officials to intervene to local communities. Rumors spread that Ebola was an excuse for medical teams to harvest organs. Angry crowed surrounded a hospital demanding the release of all patients in the end of July, 2014. However, such disruption winded down gradually. The reasons is because local notables were mobilized to mediate between the formal responses and local acceptances. Those who were respected in communities such as traditional leaders or members of community-based organizations owed roles to conjoin "formal" intervention with "informal" measures which local communities voluntarily took.

Although often overlooked, political factors and dynamics between actors at local level are key to shape policy implementation. This presentation aims to explore the political economy of implementation processes at local level, before and after a crisis. It builds on a previous study (Bertone Witter, 2015) which focused the implementation of Human Resources for Health (HRH) policies in three districts of Sierra Leone, by using a political economy framework to analyze the dynamic interactions between structure (context, historical legacies, institutions) and agency (actors, agendas, power relations). It shows that the official policies are re-shaped both by implementation challenges and by informal practices emerging locally as the result of the district-level dynamics between District Health Management Teams (DHMTs) and NGOs, with the aim of ensuring a better fit between the actors' agendas and HRH incentives. Importantly, the negotiations which shape such practices are characterized by a substantial asymmetry of power between DHMTs and NGOs.

These challenges became even more relevant during the Ebola outbreak, as new actors entered the stage at local level, with urgent priorities and limited time and interest to align and coordinate. Now, in the aftermath of the crisis, how to limit the discrepancy between central-level policies and local practices and ensure the effectiveness of policy implementation in the long-term? The presentation will also give a preliminary look at the current situation in Sierra Leone and reflect on approaches to intervention at local level which would address the implementation gap, support local governance and ownership, and benefit communities and patients.

Although recently adopted global HIV strategies have proven to be effective in expanding uptake of health services in Swaziland, this paper demonstrates that the effort to expand services rapidly and meet donor targets has also undermined patients' therapeutic experiences and overtaxed health workers, both of which are counterproductive to the ultimate goal of treatment scale-up. This paper provides insight on how the adoption of global health promoted policies play out differently when implemented in poor—resourced grassroots health facilities in rural areas of Swaziland. The paper also documents the conflicts and tensions that emanate amongst health workers when these flux policies and strategies are implemented in grassroots facilities. Furthermore, the paper demonstrates the resultant changes in the meaning of care and the shift in arrangement and administration of healthcare as influenced by an influx and permeation of global health policies into national public health systems that are burdened with disease.

The paper argues that the quest to achieve universal early access to treatment, donors must provide support that go beyond enhancing service uptake but also strengthen health systems and take seriously health worker limitations and dynamics that emanate thereof. In conclusion, the adoption of implementation science to scale-up HIV treatment should be applied with caution as it may result to bureaucratization of care delivery which becomes a deterrent and seriously affects the quality of patient experiences.

This chapter is about the role of mission health institution in Zimbabwe's public health delivery system. It argues that the new millennium marked a high point in the position and function of missionary provided health care since independence. The chapter posits that the re-emergence of mission hospitals in this period was not only de-facto but saw them assume a greater role in healthcare provision than the one they occupied during the colonial era, despite the lack of government appetite to widen their role. Changes in international development policy in the 1990s characterised by the liberal Structural Adjustment Programmes (SAPs) and the post 2000 Zimbabwean socio-economic crises resulted in a smaller role for the state and a greater role for non-state agencies, including church based NGOs. The Zimbabwean state became progressively more reliant on the services provided by these hospitals, as well as by the private sector. This chapter speaks to debates on the Zimbabwean crises and, in particular, enriches our understanding of how, despite all odds, Zimbabwe averted a human catastrophe in the post 2000 period. It refracts on institutional capacity to cope in a debilitating socio-economic environment characterised by budgetary deficits, a crumbling infrastructure, shortages of drugs and the flight of health personnel. Focusing on the operations of mission hospitals, the papers reveals the contemporary role of mission-related Christianity in Africa. In addition, the chapter also reflects on church based NGOs' purchase for policy in health issues as a prism for understanding the Church-State relations during Zimbabwe's turbulent years.

Once a model of peace building, Burundi has become, in the last two years, a deeply unstable and increasingly isolated country. The health system, which was heavily reliant on international aid -in particular for the implementation of its three flagship policies: performance-based financing, the exemption of user fees for expecting mothers and children below 5, and a low fee insurance scheme-, has not been spared: funding has diminished, international support has been drastically cut, and the drugs supply chain has become increasingly unreliable. In this paper, we study the local adaptation to this difficult situation and seek to understand which health centres have displayed a better 'resilience', understood here as maintaining quality affordable services. Beyond the idea of resilience as being simply technical feature dependent on managerial features and preparedness, we explore resilience as a function of the local political landscape and the complex interaction between nurses, chief-nurses, health facility committee members, local religious leaders, and -of course- local political leaders. Field access to Burundian health centres is uneasy and the research mostly relies on secondary data, reports, and field observations from anonymous observers. The situation is compared with the pre-crisis situation, which we documented in previous research.