Donors have struggled to effectively strengthen institutions like Sierra Leone's Ministry of Health and Sanitation (MoHS) following periods of conflict and fragility. Over multiple phases from 2002-2016: - Donor support was often unpredictable, short-term, and led to fragmented agendas that undermined MoHS legitimacy and capacity. Reforms announced by MoHS were rarely fully implemented. - Initiatives like the Free Health Care Initiative triggered some positive changes but faced implementation challenges. Donors sometimes set up parallel structures and paid higher salaries that depleted MoHS staff. - Events like the 2014 Ebola outbreak further weakened MoHS authority as emergency responses centralized control. Post-Ebola recovery saw continued