Health Sector Succession Planning and Management Practices in Sierra Leone: A Situation Analysis to Inform Health System Strengthening

Purpose: This study aimed to evaluate succession planning and management (SPM) practices as part of health system strengthening initiatives to optimize performance and impact on population health outcomes Methodology: A Mixed-method cross-sectional study design was used with both qualitative data and quantitative data collected simultaneously. The target population is middle and senior leaders within the civil service between Grade 9 and Grade 14 in the MoH, comprising healthcare professionals and administrative staff at national and district levels. For the quantitative survey, a total of 402 respondents completed the survey, representing 32% of the study population (n=1,264). For the qualitative interview, a purposive sample of twenty (20) participants was targeted among the eligible MoH personnel for this study, with a 90% (n=18) response rate. A semi-structured guide was used for the interviews, which were conducted largely in English. All interviews were audio-recorded with the participants’ consent. For the survey analysis, all 402 cases were considered, and the data analysis procedure involved both descriptive and inferential analyses, using SPSS version 25. For the analysis, Braun and Clarke’s (2006) step-by-step framework for performing thematic analysis was followed. The MAXQDA 22 software was used for the text coding and storage. Findings: The study findings revealed SPM practices are lacking or inadequate in the public health sector. The study also found that women are inadequately considered for top management positions. There is a significant relationship between gender and perceptions about women being considered for leadership positions, X2 (3, N = 402) = 8.88, p < .05. However, the relationship between gender and the other variables (occupational roles, professional cadres, and grade) shows no statistically significant difference (p > 0.05). Unique Contribution to Theory, Practice and Policy: Utilizing the Human Capital Theory and the Signaling Theory, this study evaluated the current SPM practices in the public health sector of a post-conflict setting. This study was significant to policy and practice for providing awareness of the use of effective succession planning strategies for achieving sustainability by retaining talented staff and developing future leaders to benefit the continuity of healthcare services for all Sierra Leoneans. It is recommended that the MoH, with the support of public sector oversight institutions should explore the possibility of forming a succession management committee to streamline succession issues in the health sector, with attention given to addressing workplace barriers to facilitate women’s advancement in their careers within the public health sector.