Chronicity of disruptive project rhythms: The projectification of the 'post-Ebola' health system rebuilding in Sierra Leone.

Global health development projects are inherently governed by bounded, temporal and linear time frames: the initiation, implementation and ending of time-limited interventions. This projectification of global health programmes has wide-reaching consequences as global health projects, often unsustainable and produces both new life possibilities and uncertain futures. This article highlights the temporal effects of the global health agenda on the primary health system rebuilding efforts in Sierra Leone. Attention is paid to how the projectification of public health programmes affected the primary healthcare management in a district in the southern region of Sierra Leone. Throughout this article, I develop the theoretical concept of chronicity of disruptive project rhythms where local public healthcare actors encounter project disruptions on a continuum of chronic lack. I base this concept on Manderson and Smith-Morris's definition of chronicity of illness experience, which is marked by punctuated episodes of acute sickness, where chronic patients are temporally transmuted into acute patients, while at the same time continuing to suffer from their ongoing chronic ailments. Drawing on 14 months of ethnographic research, I show how a district health management team (DHMT) contested the bounded time frames of public health funding; how waiting time for funding impacted the operation of the DHMT and, by extension, the district health system as a whole and how DHMT employees and other actors within the health system employed time-tricking strategies to resist this project time. [ABSTRACT FROM AUTHOR]