From Evidence to Policy and Action - Changing Systems Across Ministries in Sierra Leone

Every September, world leaders come to New York for the United Nations General Assembly (UNGA) to confront challenges that rarely fit neatly within the boundaries of a single ministry: health, climate change, education, jobs, technology, gender equality and economic development.

Yet too often, we still try to solve them that way.

During UNGA this year, Columbia University’s Heilbrunn Department of Population and Family Health (PopFam) welcomed a dozen high-level delegates from Sierra Leone, including ministers and senior officials spanning environment and climate change, planning and economic development, education, energy, employment and social security, gender and women’s affairs, fisheries, youth, and communications and technology. Together, we participated in a seminar on Evidence for Policy and Practice: Systems Thinking and Implementation Science, designed by PopFam.

Rather than focus on what policies Sierra Leone needs, we focused on a different question: How do we change the systems that determine whether good policies actually improve people’s lives?

We come to that question from different institutional vantage points. Government must turn evidence into decisions, implementation, and results for citizens. Universities must produce knowledge that is not only rigorous, but useful in the complex realities where policy is shaped, implemented, and experienced. Bringing those perspectives together was central to the seminar, which moved from systems thinking with Dr. Helen de Pinho, to implementation science with Dr. S. Patrick Kachur, to influencing public discourse with Professor Nicole Haberland.

It is an important question for Sierra Leone at this moment.

The country has made substantial progress. Maternal mortality, for example, fell from more than 1,600 deaths per 100,000 live births in 2000 to 354 in 2023. Yet profound challenges remain. Life expectancy is approximately 62 years; about 39 percent of the population has access to electricity; and only 17 percent uses safely managed sanitation services. Climate shocks also threaten agriculture, livelihoods and economic development.

These are not simply health, energy, environment or development problems. They are systems problems.

Consider flooding. Building a drainage channel is a technical intervention. But reducing flood losses requires understanding settlement patterns, waste management, land use, infrastructure, community behavior, government responsibilities and financing. During the seminar, we challenged one another to look beneath individual events and ask: What keeps repeating? What incentives and constraints shape behavior? Who is not in the room? What is preventing the system from changing?

We drew examples from maternal health interventions and malaria to education and women’s empowerment. The breadth of leadership in the room therefore mattered. Ministers were not simply discussing their individual portfolios; they were examining how those portfolios intersect.

The reflections were revealing. Energy Minister Cyril Grant called for a “whole-of-government approach” that recognizes that “our issues are also public health concerns.”

Employment, Labour and Social Security Minister Umaru Napoleon Koroma spoke of applying systems thinking to complex challenges so that government focuses on “doing the right things well—not the wrong things with greater efficiency.”

And Minister of Technical and Higher Education Dr. Ramatulai Wurie, reflecting on President Bio’s UNGA address, placed these ideas within a broader vision for development: “Skills are more than a pathway to work; they are a pathway to dignity, social cohesion and peace.”

These reflections capture something fundamental: complex problems do not organize themselves according to the structure of government. Health is shaped by education. Education affects employment. Energy determines whether hospitals, schools and businesses can function. Climate affects food, livelihoods and health. Technology increasingly shapes all of them.

Evidence therefore cannot stop at identifying what works. We also need to understand what works in a particular context, how it can be delivered better, whether it can be scaled, and when approaches that are not working should be changed or abandoned. That is where implementation science becomes particularly valuable: connecting evidence to the realities of policy, management and service delivery.

But that connection must also change how we work.

For government, it means creating stronger mechanisms for ministries to solve problems together rather than addressing interconnected challenges in institutional silos. It means bringing evidence into the policy process earlier, using implementation experience to adapt programmes as they are delivered, and listening systematically to the communities whose lives those policies are intended to improve. For universities, it means working more closely with policymakers and practitioners to ensure that research responds to real implementation questions and can be translated into decisions.

This is also the spirit of the partnership our institutions launched in 2025. Through a Memorandum of Understanding between Sierra Leone’s Ministry of Information and Civic Education and Columbia’s Heilbrunn Department of Population and Family Health, we committed to expanding collaboration in research, education and training—generating evidence, strengthening local expertise and helping translate knowledge into better health and development policy.

The challenge now is to carry that partnership—and the thinking behind it—beyond the seminar room and into how problems are understood and solved.

Universities cannot do that by speaking only to other universities. Governments cannot do it by working ministry by ministry. And evidence cannot improve lives if it remains disconnected from the systems that implement policies.

Changing systems requires bringing evidence closer to decision-makers, leaders across sectors closer to one another, and both closer to the people whose experiences ultimately tell us whether policies are working.

That may be one of the most important lessons we carry forward from UNGA: Our problems are connected. Our institutions, our evidence, and our actions must be, too.

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Chernor Bah is Sierra Leone’s Minister of Information and Civic Education. Dr. Thoại D. Ngô is the Harriet and Robert H. Heilbrunn Professor and Chair of the Department of Population and Family Health at Columbia University Mailman School of Public Health.