Diana Eva Szanto

This research investigates the reciprocal relationship between political culture and health system reform in Sierra Leone, with a focus on how Universal Health Coverage (UHC) policies interact with the lives of women working in the informal sector. While UHC aspires to provide equitable healthcare for all, it remains largely aspirational rather than a reality in Sierra Leone. This study asks how political values and imaginaries shape the implementation of UHC—and how those most affected by these reforms interpret their rights, responsibilities, and place within the health system. By following the trajectory of UHC policies from national institutions to frontline health facilities, and through the lived experiences of low-income women, healthcare workers, and policymakers, the project examines how health becomes a site where broader struggles over care, accountability, and social justice are negotiated. Using multi-sited ethnography and participatory methods, the study contributes to medical and political anthropology by analyzing the shifting and contested meanings of care under conditions of neoliberal reform. It seeks not only to assess whether UHC “works,” but also to explore what its implementation reveals about evolving forms of governance, citizenship, and state-society relations in post-conflict Sierra Leone.