Resources from ReBUILD’s work on health worker incentives and deployment in post-conflict and post-crisis settings
Below are details to all outputs from ReBUILD’s work on human resources for health in post-conflict and post-crisis settings.
The list below and the downloadable PDF are complete as of August 2018. The resources listed are organised on broad thematic lines, or related to specific country contexts.
For more information on ReBUILD’s work on human resources for health, contact:
Introduction: ReBUILD’s research on human resources for health in conflict and crisis affected settings
Human resources development, a very important part of health systems rebuilding after conflict or crisis, has received relatively little attention in the literature (see this BMC paper on human resource management in crisis settings) and there has been consequently little to inform decision-makers and donors. ReBUILD’s work on human resources for health (HRH) therefore 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.
The work included a large body of research on health worker incentives, which was carried out across all four of our partner countries, and research on health worker deployment systems in two partner countries, Uganda and Zimbabwe. Further work on HRH was done in Sierra Leone on the effects on the recent Ebola outbreak on health workers and the health system, and also by one of ReBUILD’s affiliate research partners on Health Workers’ Remuneration, Incentives and Accountability in Sierra Leone. Another affiliate research partner’s work on health systems’ resilience in Côte d’Ivoire, northern Nigeria and South Africa produced important findings relating to human resources for health. Running through all ReBUILD’s research has been a focus on gender and equity, and outputs from much of the specific work on gender has relevance for human resources.
Resources:
Background literature reviews on health worker incentives and deployment
Journal articles and working papers:
- Roome, E., Raven, J. and Martineau, T. (2014) Human resource management in post-conflict health systems: review of research and knowledge gaps. Conflict and Health 2014, 8:18 http://conflictandhealth.biomedcentral.com/articles/10.1186/1752-1505-8-18
- Witter, S., Tulloch, O. & Martineau, T. (2012) Health workers’ incentives in post-conflict settings – a review of the literature and framework for research. ReBUILD Research Report. https://rebuildconsortium.com/media/1265/rebuild_report_2_v6.pdf
Briefs:
- Managing human resources in post-conflict health systems: a review of research and knowledge gaps https://rebuildconsortium.com/media/1102/rebuildconsort-managinghumanresourcev3.pdf
Cross-country synthesis and theoretical work on health worker incentives, deployment and HRH
Journal articles and working papers:
- Witter, S, Wurie, H, Namakula, J, Mashange, W, Chirwa, Y and Alonso‐Garbayo, A (2018) Why do people become health workers? Analysis from life histories in 4 post‐conflict and post‐crisis countries. Int J Health Plann Mgmt. 2018; 1–11; http://onlinelibrary.wiley.com/doi/10.1002/hpm.2485/epdf
- Witter, S., Wurie, H., Chandiwana, P., Namakula, J., Sovannarith, S., Alonso-Garbayo, A., Ssengooba, F and Raven, J. (2017) How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia. Health Policy and Planning, Volume 32, Issue suppl_3, 1 November 2017, Pages iii3–iii13, https://doi.org/10.1093/heapol/czx112
- Witter, S., Namakula, J., Alonso-Garbayo, A., Wurie, H., Theobald, S., Mashange, W., Ros, B., Buzuzi, S., Mangwi, R and Martineau, T. (2017) Experiences of using life histories with health workers in post-conflict and crisis settings: methodological reflections. Health Policy Plan 2017, 1–7 https://academic.oup.com/heapol/article-lookup/doi/10.1093/heapol/czw166
- Witter, S., Bertone, M., Chirwa, Y., Namakula, J., So, S and Wurie, H. (2017) Evolution of policies on human resources for health: opportunities and constraints in four post-conflict and post-crisis settings. Conflict and Health 2017 10:31 http://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-016-0099-0
- Bertone, M. and Witter, S. (2015) The complex remuneration of Human Resources for Health in low income settings: policy implications and a research agenda for designing effective financial incentives. Human Resources for Health, 13; 62. http://www.human-resources-health.com/content/pdf/s12960-015-0058-7.pdf
- Witter, S. Falisse, J-B., Bertone, M, Alonso-Garbayo, A., Martins, J., Salehi, A., Pavignani, E. and Martineau, T. (2015) State-building and human resources for health in fragile and conflict-affected states: exploring the linkages http://human-resources-health.biomedcentral.com/articles/10.1186/s12960-015-0023-5
- Witter, S., Mashange, W., Namakula, J., Wurie, H.R., Ssengooba, F. and Alonso-Garbayo, A. (2017) Incentives for health workers to stay in post and in rural areas: findings from four conflict- and crisis-affected countries. ReBUILD RPC Working Paper No. 26.
Briefs:
- Establishing a responsive and equitable health workforce post conflict and post crisis: lessons from ReBUILD research. https://rebuildconsortium.com/media/1486/health-workers-brief-2016.pdf
Presentations:
- Research on health worker policies, incentives and retention in post-conflict countries: an overview of ReBUILD work. Combined presentations given at the 22nd Canadian Conference on Global Health, 5th November 2015, Montreal (opens an eternal site) http://www.slideshare.net/ReBUILD_Consortium/research-on-health-worker-policies-incentives-and-retention-in-postconflict-countries-an-overview-of-rebuild-work-62753579
Health worker incentives: Sierra Leone
Journal articles and working papers:
- Bertone MP, Lagarde M, Witter S, (2016) Performance-Based Financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone. BMC Health Services Research 16:286 http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1546-8
- Wurie, H., Samai, M., Witter, S. (2016) Retention of health workers in rural Sierra Leone: findings from life histories. Human Resources for Health, 14 (3). http://www.human-resources-health.com/content/pdf/s12960-016-0099-6.pdf
- Bertone, M. and Lagarde, M. (2016) Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone Health Policy & Planning (2016) doi: 10.1093/heapol/czw031 http://heapol.oxfordjournals.org/content/early/2016/04/06/heapol.czw031.abstract
- Bertone, M. and Witter, S. (2015) An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone. Social Science and Medicine, volume 141, pp56-63. http://www.sciencedirect.com/science/article/pii/S0277953615300447
- Witter, S., Wurie, H. And Bertone, M. (2015) The Free Health Care Initiative: how has it affected health workers in Sierra Leone? Health Policy and Planning journal, 1-9 http://heapol.oxfordjournals.org/content/31/1/1
- Bertone, M., Samai, M., Edem-Hotah, J. and Witter, S. (2014) A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002-2012. Conflict and Health, 8:11. http://www.conflictandhealth.com/content/pdf/1752-1505-8-11.pdf
- Witter, S., Wurie, H. and Bertone, M. (2014) The Free Health Care Initiative: how has it affected health workers in Sierra Leone? Report for ReBUILD. https://rebuildconsortium.com/media/1014/the-free-health-care-initiative-how-has-it-affected-health-workers-in-sierra-leone.pdf
- Wurie, H., Samai, M. and Witter, S. (2014) Policies to attract and retain health workers in Sierra Leone: routine human resource data analysis. Report for ReBUILD.
- Witter, S., Bertone, M, Wurie, H, Samai, M., Edem-Hotah, J., Amara, R. (2014) Health worker incentives post-conflict: survey report from Sierra Leone. Report for ReBUILD. http://www.rebuildconsortium.com/media/1193/hwisreportslfinal.pdf
- Bertone, M. and Witter, S. (2014) The development of HRH policy in Sierra Leone, 2002-2012 – report on key informant interviews. Report for ReBUILD. http://www.rebuildconsortium.com/resources/research-reports/the-development-of-hrh-policy-in-sierra-leone-2002-2012-ki-interviews/
- Wurie, H. And Witter, S. (2014) Serving through and after conflict: life histories of health workers in Sierra Leone. Report for ReBUILD. http://www.rebuildconsortium.com/resources/research-reports/serving-through-and-after-conflict-life-histories-of-health-workers-in-sierra-leone/
- Bertone, M, Edem-Hotah, J., Samai, M. and Witter, S. (2014) The development of HRH policy in Sierra Leone, 2002-2012 – a document review. Report for ReBUILD. http://www.rebuildconsortium.com/media/1019/the-development-of-hrh-policy-in-sierra-leone-2002-2012-a-document-review.pdf
Briefs:
- Evidence for supporting a skilled health workforce for all in Sierra Leone. https://rebuildconsortium.com/media/1269/rebuild-sl-policy-brief-4-evidence-for-supporting-a-skilled-health-workforce.pdf
- A window of opportunity for reform? The case of policy on human resources for health in Sierra Leone after the conflict (2002-2012). https://rebuildconsortium.com/media/1101/rebuildconsort-aspecialbrief.pdf
- Incentives to improve health workers’ retention and motivation: implementation challenges and informal practices at district level. The role of DHMTs and NGOs https://rebuildconsortium.com/media/1268/rebuild-sl-policy-brief-3-hrh-practices-at-district-level.pdf
- Exploring the remuneration of primary healthcare workers: findings on incomes and income use strategies. What lessons can be learnt to design effective financial incentives? https://rebuildconsortium.com/media/1267/rebuild-sl-policy-brief-2-hw-incomes.pdf
Presentations:
- Evidence for supporting a health workforce for all in Sierra Leone. Combined presentations given at a meeting of policy makers and implementers in Freetown, Sierra Leone, to present ReBUILD findings and discuss priorities and challenges for supporting an effective health workforce for all communities (Opens in an external site) http://www.slideshare.net/ReBUILD_Consortium/evidence-for-supporting-a-health-workforce-for-all-in-sierra-leone-rebuild-hrh-research
Health workers and Ebola in Sierra Leone
Journal articles and working papers:
- Raven, J, Wurie, HR and Witter, S. (2018). Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study. (2018) BMC Health Services research 18:251 https://doi.org/10.1186/s12913-018-3072-3
- Wurie, H., Witter, S. & Raven, J. (2016) ‘Fighting a battle’: Ebola, health workers and the health system in Sierra Leone. ReBUILD Working Paper https://rebuildconsortium.com/resources/research-reports/fighting-a-battle-_-ebola-_-health-workers-and-the-health-system-in-sierra-leone/
Video:
- Haja Wurie speaks about the health workforce and Ebola in Sierra Leone. This video was made by the COUNTDOWN RPC but covers evidence and experiences from ReBUILD’s research during the Ebola outbreak.
Health worker incentives and deployment: Uganda
Journal articles and working papers:
- Ayiasi, R.M., Rutebemberwa, E. and Martineau, T. (2017) Understanding deployment policies and systems for staffing rural areas in Northern Uganda during and after the conflict: Synthesis report ReBUILD RPC Working Paper No. 25 https://rebuildconsortium.com/resources/research-reports/understanding-deployment-policies-and-systems-for-staffing-rural-areas-in-northern-uganda-during-and-after-the-conflict_synthesis-report/
- Namakula, J., Witter, S. and Ssengooba, F. (2016) Health worker experiences of and movement between public and private not-for-profit sectors – findings from post conflict Northern Uganda. Human Resources for Health, 14:18. http://www.human-resources-health.com/content/14/1/18
- Namakula, J. and Witter, S. (2014) Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems. Health Policy and Planning Health Policy and Planning, vol. 29, pp ii6–ii14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202915/
- Namakula, J., Witter, S. and Ssengooba, F. (2014) Health worker incentives policies during and after the conflict in northern Uganda: a document review. Report for ReBUILD. http://www.rebuildconsortium.com/media/1013/health-worker-incentives-during-and-after-the-conflict-in-northern-uganda.pdf
- Namakula, J. and Witter, S. (2014) Policies to attract and retain health workers in Northern Uganda during and after conflict: findings of key informant interviews. Report for ReBUILD. http://www.rebuildconsortium.com/media/1017/policies-to-attract-and-retain-health-workers-in-northern-uganda-during-and-after-conflict.pdf
- Namakula, J., Witter, S., Ssengooba F. and Ssali, S. (2013) Health worker’s career paths, livelihoods and coping strategies in conflict and post-conflict Northern Uganda. ReBUILD Consortium report. http://www.rebuildconsortium.com/media/1021/health-workers-career-paths-livelihoods-and-coping-strategies-in-conflict-and-post-conflict-uganda.pdf
Briefs:
- Maintaining an effective health workforce during and after conflict: Evidence from ReBUILD’s research in northern Uganda https://rebuildconsortium.com/media/1351/uganda-hwi-research-brief-may-16-a.pdf
Health worker incentives and deployment: Zimbabwe
Journal articles and working papers:
- Chirwa, Y., Chandiwana, P., Pepukai, M., Mashange, W., Buzuzi, S., Munyati, S., Martineau,T. and Alonso-Garbayo, A. (2016) Deployment of Human Resources for Health in Zimbabwe: Synthesis report ReBUILD RPC Working Paper https://rebuildconsortium.com/resources/research-reports/deployment-of-human-resources-for-health-in-zimbabwe_synthesis-report/
- Chirwa, Y, Witter, S, Munjoma, M, Mashange, W, McPake, B and Munyati, S. (2016) The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe. BMC Health Services Research 2013 13:197 http://bit.ly/HRHUserFeesinZim
- Chirwa, Y., Witter et al. (2016) Understanding health worker incentives in post-crisis settings: policies to attract and retain health workers in Zimbabwe since 1997: health worker survey findings. ReBUILD report. https://rebuildconsortium.com/media/1345/understanding-health-worker-incentives-in-three-districts-of-zimbabwe-survey-report-final.pdf
- Chirwa, Y., Witter et al. (2016) Understanding health worker incentives in post-crisis settings: policies to attract and retain health workers in Zimbabwe since 1997: findings from in-depth interviews and life histories with health workers. ReBUILD report. https://rebuildconsortium.com/media/1333/rebuild_working-paper_17_zimhwidi.pdf
- Chirwa, Y., Witter et al. (2015) Understanding health worker incentives in post-crisis settings: policies to attract and retain health workers in Zimbabwe since 1997: Key informant interviews. ReBUILD report. https://rebuildconsortium.com/media/1278/rebuild_report_16_zimbabwe_hw_kii.pdf
- Chirwa, Y, Witter et al. (2015) Understanding health worker incentives in post-crisis settings: policies to attract and retain health workers in rural areas in Zimbabwe since 1997 – a document review. ReBUILD report. http://rebuildconsortium.com/resources/research-reports/understanding-health-worker-incentives-in-post-crisis-settings-a-document-review-of-zimbabwe/
Briefs:
- The challenge of retaining health workers in Zimbabwe: findings from ReBUILD research https://rebuildconsortium.com/media/1254/zim-project-2-briefing-aug-2015.pdf
Health worker incentives: Cambodia
Journal articles and working papers:
- Ensor, T., So, S. and Witter, S. (2016) Exploring the influence of context and policy on health district productivity in Cambodia. Cost effectiveness and resource allocation, 14:1.http://www.resource-allocation.com/content/14/1/1
- So, S. and Witter, S. (2016) The evolution of human resources for health policies in post-conflict Cambodia: findings from key informant interviews and document reviews. ReBUILD Working Paper. https://rebuildconsortium.com/resources/research-reports/the-evolution-of-human-resources-for-health-policies-in-post-conflict-cambodia-_-findings-from-key-informant-interviews-and-document-reviews/
- So, S., Alonso-Garbayo, A. and Witter, S. 2016. Learning from the experiences of health workers in conflict-affected Cambodia to improve motivation and retention: analysis of life histories. ReBUILD RPC Working Paper. https://rebuildconsortium.com/resources/research-reports/learning-from-the-experiences-of-health-workers-in-conflict-affected-cambodia-to-improve-motivation-and-retention-analysis-of-life-histories/
Gender and human resources for health
Journal articles and working papers:
- Percival, V., Richards, E., MacLean, T. and Theobald, S. (2014) Health systems and gender in post-conflict contexts: building back better? Conflict and Health2014, 8:19 http://conflictandhealth.biomedcentral.com/articles/10.1186/1752-1505-8-19
- Witter, S., Namakula, J., Wurie, H., Chirwa, Y., So, S., Vong, S., Ros, B., Buzuzi, S. and Theobald, S; The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts Health Policy and Planning, 32, suppl 5, 1 December 2017 pp v52–v62, https://doi.org/10.1093/heapol/czx102
- Sarah N. Ssali, Sally Theobald, Justine Namakula and Sophie Witter (2016) Building post-conflict health systems: a gender analysis from Northern Uganda. Chapter 20 in the Handbook on Gender and Health, edited by Jasmine Gideon and published by Edward Elgar 27 May 2016. (Part of the International Handbooks on Gender series) ISBN: 9781784710859 DOI: http://dx.doi.org/10.4337/9781784710866
- Sarah Ssali and Sally Theobald (2016) Using life histories to explore gendered experiences of conflict in Gulu District, northern Uganda: Implications for post-conflict health reconstruction. South African Review of Sociology Volume 47, Issue 1, 2016 http://www.tandfonline.com/doi/abs/10.1080/21528586.2015.1132634
- Dhatt, S. Theobald, S. Buzuzi, et al. (2017) The role of women’s leadership and gender equity in leadership and health system strengthening. Global Health, Epidemiology and Genomics (2017), 2, e8, page 1 of 9. doi:10.1017/gheg.2016.22
Specific resources on gender and equity in post-conflict health systems:
The outputs from ReBUILD’s collaborative work with the Gender Working Group of the Stockholm International Peace Research Institute (SIPRI) Global Health and Security Programme were developed into ‘Building Back Better‘ – a set of resources, including case studies, on gender in post-conflict health systems.
Briefs:
- Hyde S. and Buzuzi S. (2017) “How gender roles and relations affect health workers’ training opportunities and career progression in post-crisis rural Zimbabwe.” buildingbackbetter.org.
- Vong, S., Hyde S. and Hawkins K. (2017) “Promoting women’s leadership in the post-conflict health system in Cambodia” buildingbackbetter.org.
Cross-cutting and general health systems articles:
Journal articles and working papers:
- Raven, J. Baral, S. Wurie, H. Witter, S. Samai, M. Paudel, P, Subedi, H.N. Martineau, T. Elsey, H. Theobald, S. (2018) What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal Health Research Policy and Systems
- Bertone, M, Falisse, J-B, Russo, G and Witter, S. (2018) Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems. PLoS ONE 13(4) https://doi.org/10.1371/journal.pone.0195301
- Martineau, T., McPake, B., Theobald, S., Raven, J., Ensor, T., Fustukian, S., Ssengooba, F., Chirwa, Y., Vong, S., Wurie, H, Hooton, N and Witter, S. (2017) Leaving no one behind: lessons on rebuilding health systems in conflict and crisis-affected states. BMJ Global Health Jul 2017, 2 (2) http://gh.bmj.com/content/2/2/e000327
- Martineau, T, Woodward, A, Sheahan, K and Sondorp, E. (2017) Health systems research in fragile and conflict affected states: a qualitative study of associated challenges. Health Research Policy and Systems 15:44 https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-017-0204-x DOI: 10.1186/s12961-017-0204-x
- Woodward, A., Sondorp, E., Witter, S. and Martineau, M. (2016) Health systems research in fragile and conflict affected states: a research agenda-setting exercise. Health Research Policy & Systems. 14:51. http://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-016-0124-1
- Ager, A., Lembani, M., Mohammed, A., Ashir, GM., Abdulwahab, A., de Pinho, H., Delobelle, P. and Zarowsky, C. (2015) Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building. Conflict and Health 2015 9:30
- McPake, B., Witter, S., Ssali, S., Wurie, H., Namakula, J. and Ssengooba, F. (2015) Ebola in the context of conflict affected states and health systems: case studies of Northern Uganda and Sierra Leone. Conflict and Health; 9; 23. http://www.conflictandhealth.com/content/9/1/23
- McPake, B., Witter, S., Ensor, T., Fustukian, S., Newlands, D., Martineau, T. and Chirwa, Y. (2013) Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources. Human Resources for Health, 11(1):46. http://www.human-resources-health.com/content/11/1/46/abstract
- Witter, S. (2012) Health financing in post-conflict states: what do we know and what are the gaps? Social Science and Medicine, vol. 75, p.2370-2377. http://www.sciencedirect.com/science/article/pii/S0277953612006752
Presentations:
- Human Resources in Fragile and Conflict-Affected settings – cross sectoral issues between health and education. Overview presentation by Tim Martineau for seminar on human resources in health and education in fragile and conflict affected settings, organised by HEART in June 2016. https://rebuildconsortium.com/resources/presentations/human-resources-in-fragile-and-conflict-affected-settings-_-cross-sectoral-issues-between-health-and-education/
- Human Resources for Health in Post-Conflict settings – Findings from ReBUILD research. Presentation given in June 2016 by Sophie Witter on the ReBUILD programme’s findings on Human Resources for Health in Post-Conflict settings, at a meeting exploring cross-sectoral learning on human resources in health and education sectors in fragile settings. https://rebuildconsortium.com/resources/presentations/human-resources-for-health-in-post-conflict-settings-_-findings-from-rebuild-research/
- Health workforce recruitment and financing – selected issues for consideration. Presentation given by Tim Martineau at the Human Resources for Health Summit in Freetown, Sierra Leone, 2nd June 2016 https://rebuildconsortium.com/resources/presentations/health-workforce-recruitment-and-financing-selected-issues-for-consideration/
ReBUILD’s general briefs and issue briefs on health systems in conflict and crisis affected settings:
Health systems after conflict; evidence for better policy and practice
A series of four overview briefs on ReBUILD’s phase 1 research, cross-cutting findings and lessons
Health systems during and after crisis; evidence for policy and practice
A series of briefs on priority research topics for crisis-affected contexts in 2017/18.
- Resilience of health systems during and after crises – what does it mean and how can it be enhanced?
- The political economy of crisis-affected settings: what does it mean for investments in health systems?
- Sustainability of health systems in crisis-affected settings: lessons for practice
- What do we know about how to respond to humanitarian crises in ways that also contribute to subsequent stronger health systems?
- Performance-based financing in fragile and conflict-affected settings: what are the opportunities and challenges?