Research for stronger health systems post conflict

ReBUILD's work on health worker incentives and remuneration

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Health worker incentives research

Our focus

Human resources development is an important part of ReBUILDing the health sector post-conflict but has received relatively little attention in the literature and may be overlooked by decision-makers and donors. No study to date has focused on how the decisions made, or not made, in the post-conflict period can affect the longer term pattern of attraction, retention, distribution and performance of health workers, and thus ultimately the performance of the sector.

In our health worker incentive research, which is being undertaken in all four focal ReBUILD countries, we ask how incentive environments have evolved in the shift away from conflict in each country, and what drove this process. We analyse changing HRH policies and their effects, intended and unintended, and draw from this lesson for future, better interventions. The project protocol summary for this work can be downloaded here.

Our research methods look back over the period since the conflict or crisis and are based on analysis of documents and HR data, combined with surveys of staff and key informant interviews. Career histories have proved particularly effective at highlighting staff experiences of conflict and post-conflict periods and policies.

ReBUILD's work on health worker incentives also includes a further line of research being conducted by ReBUILD's Affiliate partners at the London School of Hygiene and Tropical Medicine, into health workers' incentives, remuneration and accountability in Sierra Leone.

Findings

Research emerging from northern Uganda highlights experiences of conflict and the resilience shown by those who chose to stay and continue to serve during the long-standing recent conflict, and the need for more effective protection of staff and recognition of their contribution.

The extent of a ‘window of opportunity’ post-conflict to reset health systems on a different path is examined in one of our papers on Sierra Leone, using HRH policy development as a case study. We find that the Free Health Care Initiative in 2010 catalysed major changes for HRH, and bring results together across research tools, we analyse its overall effects on health workers. Health staff have since been hit by the Ebola epidemic, and an ongoing research project is examining coping strategies and lessons for increasing resilience of health system and staff. ReBUILD findings are also being shared with agencies involved in post-Ebola planning.

Ongoing work In Zimbabwe will analyse differences in incentive packages across public, municipal, rural district council, mission and private sectors, and how these are distorting service delivery, while in Cambodia, the different phases in HRH policy-making post-conflict and the challenges that remain, especially in under-served areas, will be presented.

Our future work will focus on drawing lessons across countries on effective incentive policies and packages in different contexts, and on over-arching themes, such as the potential contribution of HRH to state-building in conflict-affected settings.