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Background: In the last decade participatory approaches have gained prominence in policy-making, becoming the focus of good policy-making processes. Policy dialogue is recognised as an important aspect of policy-making among several interactive and innovative policy-making models applied in different contexts and sectors. Recently there has been emphasis on the quality of policy dialogue in terms of how it should be conducted to attain participation and inclusiveness. However, there is paucity of evidence on how the context influences policy dialogue, particularly participation of stakeholders. Liberia’s context, which is characterised as post-war, highly donor dependent and in recovery from the recent catastrophic Ebola outbreak, provides an opportunity to understand the influence of context on policy dialogue. Methods: This was an exploratory study using qualitative methods. Key informant interviews were conducted using an interview guide. A total of 16 interviews were conducted, 12 at the national level and 4 at the sub national level. Data were analysed using inductive thematic content analysis. Results: The respondents felt that the dialogues were a success and involved important stakeholders; however, there were concerns about the improper methodology and facilitation used to conduct them. Opinions among the respondents about the process of generating and selecting the themes for the dialogues were extremely divergent. Both before and during the Ebola outbreak, the context was instrumental in shaping the dialogues according to the issue of focus, requirements for participation and the decisions to be made. Policy dialogues have become a platform for policy discussions and decisions in Liberia. It is a process that is well recognised and appreciated and is highly attributed to the success of the negotiations during the Ebola outbreak. Conclusions: To sustain and strengthen policy dialogues in future, there needs to be proper information sharing through diverse forums and avenues, stakeholders’ empowerment and competent facilitation. These will ensure that the process is credible and legitimate.
Liberia is a post-civil war state, where the conflict, which ran between 1989 and 2002, devastated the country’s economy, human capacity, infrastructure and security [13]. Recovery efforts began in 2006 after President Johnson Sirleaf came to power [14, 15]. Despite the efforts and strides, Liberia still has a long way to go. It is estimated that it is one of the poorest countries in Africa, with an average per capita income of US$ 160 [16]. Likewise, the health indicators have suffered from the country’s plight. In 2010 life expectancy at birth was 59.3 and infant mortality rate per 1,000 live births was 91.3. In 2008 the maternal mortality rate per 1000,000 live births was 990 [14]. Several donors have come to assist Liberia rebuilt. However, the aid architecture has been rife with criticism, including its effect on harmonisation and alignment to Liberia’s needs [13, 15]. Recently, the Ebola outbreak weakened the already stressed systems, economy and performance, adding to the country’s predicaments [17]. There is one promising element, though: policy dialogues have been going on in the health sector to help strengthen policy-making. The main areas of focus have been the development, implementation and monitoring of the health sector strategic plan; integrated monitoring and evaluation; capacity building with a focus on planning and budgeting; and operationalization of health financing. This was an exploratory study using qualitative methods. The research was conducted primarily through key informant interviews with various stakeholders. The interviews were conducted using a guide and were carried out by a Liberian researcher conversant with qualitative research and the context. The interview guide was pretested with health systems technical officers in the WHO Regional office and adjusted accordingly prior to conducting interviews. The initial list of respondents was drawn with the officials responsible for the dialogues at the Ministry of Health (MoH). This was followed with snowballing to identify additional respondents until descriptive saturation [18]. Respondents included a range of stakeholders at the national level such as the MoH and other relevant ministries, donors and nongovernmental organisations (NGOs). The respondents at the subnational level included sub-national health management team members and NGO representatives. A total of 16 interviews were conducted with 12 national and 4 subnational level respondents. Table 1 presents details of the respondents and their organisations. Data were collected between June and August 2015 after the Ebola outbreak of 2014. Respondents’ organisations The national level stakeholders were interviewed in Monrovia, the capital city and where their various institutions were headquartered. Grand Bassa and Bong counties hosted the county level interviews. These counties were selected based on ease and convenience of access in consideration of the resource and time limitations and travel constraints due to the heavy rains and poor road infrastructure. Data collection focused on five broad areas and aimed to assess the effectiveness of the policy dialogue programme in Liberia. These areas were contextualisation and understanding of the dialogue, governance and management of the dialogues, policy dialogue processes, policy dialogue outcomes, and policy dialogues around the Ebola response. Table 2 lists the areas and parameters that were assessed. Data collection domains The transcripts, which were in English, were analysed by two coders both of whom are authors of this paper. As a first step to formal analysis, we read the interviews in detail looking for emerging issues in line with the study objectives and these were coded and categorised into themes. One of the coders created a start list of the themes that were in line with the objectives of the study. Both coders read through all the transcripts independently and coded them using QSR NVivo 10. The two coders then selected the quotations that best represented each theme and sub-theme. The quotations selected by both coders were included as representative of the others.
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