Leadership Transition in the Sierra Leone Public Health Sector: Is it Succession or Supercession?

Abstract

Purpose: This study aimed to shed light on the leadership transition dynamics in the public health sector by exploring the factors hindering the effective implementation of succession planning and management (SPM) in the Sierra Leone Ministry of Health (MoH).

Methodology: A qualitative study design was used to understand the current leadership transition practices in the MoH. The study population is middle and senior leaders within the civil service between Grades 9 and 14. A purposive sample of eighteen (18) participants was interviewed, using a semi-structured guide. All interviews were audio-recorded with the participants’ consent. 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 findings of this study point to a severe crisis in public health management capacity, driven by the lack of a structured system to develop and retain future leaders. The critical barriers that hinder succession planning were identified in three main themes: (1) Politics and nepotism (2) weak performance evaluation mechanism and (3) lack of resources/costs. Politics and tribalism were considered serious threats to succession planning. Some of the participants referred to the current practices in relation to leadership transition in the MoH as “supercession” and not succession. Generally, the study highlighted the following: Leadership and Governance Deficit: Effective public health management relies on strong, competent leadership at all levels. The lack of an effective succession management system creates a vacuum in management capacity, weakening the MoH's ability to coordinate, implement, and evaluate public health programs effectively.  Erosion of Management Systems: The weak performance evaluation mechanism identified in the study is a fundamental management failure. When performance appraisals are flawed and not linked to promotions, it dismantles accountability, demotivates staff, and removes any objective basis for management decisions regarding career advancement. Operational and Financial Inefficiency: The lack of dedicated resources for SPM reflects poor financial management and a short-term perspective. The cost of not planning (frequent leadership crises, loss of institutional knowledge, poor staff morale, and constant external recruitment) is likely far higher than the investment in developing internal talent. This inefficiency undermines the return on investment in the health sector. Sierra Leone's efforts to strengthen its health system and achieve universal health coverage will be severely compromised by a recurring cycle of leadership instability and management failure.

Unique Contribution to Theory, Practice and Policy: Succession Planning is a cornerstone of strategic human resources for health and the absence of a functional SPM system signifies a major gap in national health sector strategic planning. Utilizing the Human Capital Theory and the Signaling Theory, this study sought to understand the leadership transition practices in the public health sector of a post-conflict setting. The study revealed the weak strategic human resource planning in the MoH. The MoH's health sector plans lack the necessary components to build a sustainable leadership pipeline, threatening the long-term viability of all health programs. This study is important for policy and practice because it raises awareness about effective succession planning strategies that help in achieving sustainability by retaining talented staff and developing future leaders in the public health sector.