Research for stronger health systems during and after crisis

Communities

 

Human resources for health is the most expensive, complex and critical health system pillar, and one with more political ramifications – it is crucial to learn lessons about how to rebuild the health workforce effectively post-conflict.

Health worker attraction, retention, distribution and performance are particularly important factors affecting the performance of a health system. In post-conflict settings, where health systems and health worker livelihoods have been disrupted, the challenges facing the establishment of the right posting and incentive environment are particularly important, and the contextual dynamics around them especially important to understand and incorporate sensitively into policy measures. REBUILD therefore chose this topic as one of its focus areas for the first stage of research.

A cross-cutting analysis of ReBUILD’s wide-ranging series of studies since 2011, on health worker incentives and on deployment policies, has produced a number of important findings and recommendations, and have informed some key themes around human resources for health in post-conflict settings.

These sub-themes are:

Household structure

Conflict has impacts on demographic structure and in consequence, on household structure.

In addition to an increase in female headed households, children may have been targeted through conscription, or have been more vulnerable to the indirect impacts of conflict, causing a ‘missing generation’ affecting both demographic, household and extended family structures.

These changes can affects the extent to which people are facilitated to access health care; and are protected from impoverishing costs.

Axes of vulnerability

Poverty, gender, and age are generally associated with capacities for resilience or vulnerabilities in all communities.

Conflict creates new vulnerabilities, for example by increasing the prevalence of disability and of female headed households that may for example be disadvantaged in labour markets.

Sometimes these dimensions are also sources of resilience – in some contexts, female headed households have been shown to prioritise health expenditure more than male headed ones.

Accessing healthcare

In the absence of sufficient resources at household level or from the extended family, poor households can struggle to access healthcare.

They can also end up excluded from the community support mechanisms, based on reciprocal small loans and gifts, which are important sources of resilience to health related shocks during conflict affected periods.

People’s access to health care is therefore affected by changes to household and extended family structures especially the balance between productive and non-productive household members.

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