Research for stronger health systems during and after crisis

Understanding human resources for health recruitment and deployment in post-conflict settings

Lead: Alvaro Alonso-Garbayo

Group of smiling men an d women standing on the steps of a building
The District Health Management Team and researchers in Ermera district

Purpose of the research

This study contributes to ReBUILD’s work on the evolution of human resource (HR) management policies and practices for staff recruitment and deployment during and after conflict or crisis.  The study aims to improve understanding of how recruitment and deployment policies, processes and practices contribute to an effective health workforce coverage including a gender and equity lens after the conflict in Timor Leste. The study covers the period from the resolution of the conflict to the present.

Countries and policy context

Timor Leste experienced 24 years of conflict before gaining independence from Indonesia in 2002. Since then, recruitment and deployment systems have been key for the rehabilitation of the health workforce, and continue to play an important role in ensuring that the appropriate health workers are attracted and incorporated into an expanding health system.

 

A woman in a white coat examines a child in a bedExpected areas of influence

The project is primarily working with the Timor Leste Ministry of Health but it also links to other government agencies such as the Public Service Commission, the Ministry of Education and the Ministry of Finances. With the engagement of these stakeholders, it is expected that findings from the study will support the implementation and achieve the objectives of the Timor Leste’s National Health Workforce Plan 2018-22 by strengthening the recruitment and deployment of health workers including gender and equity perspectives.


The results will also be useful in countries at similar stages of rebuilding their health workforce following conflict or crisis, or others not affected by conflict but involved in developing their health workforce. The study supports the implementation of the new WHO ‘Global strategy on human resources for health: Workforce 2030’ by providing evidence to inform policy making to optimise workforce performance.


The government of Timor Leste, development partners and the donor community will also benefit from the results of this study by better understanding where their investment in the health workforce could yield better returns. From an academic perspective, the evidence produced through this study will feed into an evolving conceptual framework to explore human resources management in the health sector which is an under-theorised area.

 
Above image: Young doctors examining a patient in Los Palos  

Progress

A stakeholder engagement exercise was carried out in April 2017 during which main stakeholders, including the Prime Minister (former Minister for Health), senior decision-makers from the Ministry of Health, Ministry of Education, National University of Timor Leste, Public Service Commission and the World Health Organization, were briefed about the project, asked to provide their suggestions to ensure alignment of research objectives with the country needs and to obtain their commitment for collaboration and support. Ethical approval was received from Liverpool School of Tropical Medicine and the National University of Timor Leste.

 

Two men and a woman standing and smiling beside a sign that reads 'Ministerio da Saude'

Alvaro with the Timorese research team, Dr Joao Martins and Sara Pereira

 

A literature review assessed the existing global knowledge in this area and helped refine further the research objectives. A Public Administration document review was carried out to identify relevant policies and processes related to recruitment and deployment and to assess changes introduced. Key informants were interviewed in depth about how decisions about these policies and processes were made in the different stages covered by the study, which actions were taken, which were the drivers of changes introduced and the influences from the context in which these decisions were made. To assess how these policies and processes were implemented we interviewed front-line health workers and their managers in three different districts. All interviews have now been completed, transcribed and translated and are currently being analysed. Collection of current and retrospective quantitative workforce data to assess the impact of recruitment and deployment systems on the evolving workforce effective coverage is ongoing. The project is expected to be completed by the end of 2018.

 

Resource lists

Resources from ReBUILD's work on human resources for health.