Research for stronger health systems during and after crisis

Deployment systems for health workers in remote and rural areas

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ReBUILD is conducting research to identify ways to improve deployment systems to rural and remote areas used by large employers of health personnel in post-conflict or post-crisis settings. This work is being done in Uganda and in Zimbabwe.

Background:

In the past decade the initial emphasis in tackling the so-called “human resources for health crisis” has been on scaling up the health workforce. However, the maldistribution of health workers and the associated difficulty of filling health worker posts in rural and remote areas have long been recognised as a serious challenge to the equitable provision of healthcare. A major part of the problem is that for a variety of reasons posts in these areas are less attractive than posts in urban areas. Whilst work needs to be done in making jobs more attractive in these areas, little has been done so far on how the administrative systems for deployment in large organisations have been used in the post conflict/crisis period to address shortages in rural and remote areas. In this regard much research has already been devoted to understanding health worker behaviour in relation to taking up and remaining in posts in different locations.

Our study:

This study aims to improve deployment systems to rural and remote areas used by large employers of health personnel in post conflict/crisis settings. It describes the current deployment policy and systems, and how and why they have changed over time since the emergence from the crisis. It assesses the impact on staffing of rural and remote areas of the key changes to deployment policy and systems. The study takes place in three districts in Zimbabwe and three in Uganda. It uses a largely qualitative approach, asking health workers and managers at different levels and sectors (e.g. government and non-government) and using analysis of their narratives to generate data about their experiences and knowledge about policies and regulations governing deployment before, during and after the conflict/crisis. Life/job histories were also used to analyse health workers’ career experiences as well as analysis of documents and administrative records. The project protocol summary for this work can be downloaded here.

At the moment the study is on its analysis phase but we expect some preliminary results soon showing how the socio-political and economic crisis in Zimbabwe and the armed conflict in Uganda affected workers’ and mangers' experiences and how policy and regulatory frameworks were adapted in each phase of both crises.