Image Credit  – Maria Bertone


ReBUILD and human resources for health

ReBUILD’s work on human resources for health (HRH) looked at how the decisions made in the post-conflict period affected the longer-term pattern of attraction, retention, distribution and performance of health workers. It produced an extensive body of work –  all of ReBUILD’s resources relating to human resources for health are here.


Research projects

Health worker incentives

This work, undertaken in all four focal ReBUILD countries, explored how incentive environments evolved in the move away from conflict and what drove this process. The research analysed changing HRH policies and their effects, intended and unintended, and drew lessons for future, better interventions. All related resources are here with highlights below.


Witter, S., H. Wurie, P. Chandiwana, J. Namakula, S. So, A. Alonso-Garbayo, F. Ssengooba and J. Raven (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 32(suppl_3): iii3-iii13.


Wurie, H. R., M. Samai and S. Witter (2016). “Retention of health workers in rural Sierra Leone: findings from life histories.” Hum Resour Health 14: 3. doi:


Witter, S., M. P. Bertone, Y. Chirwa, J. Namakula, S. So and H. R. Wurie (2016). “Evolution of policies on human resources for health: opportunities and constraints in four post-conflict and post-crisis settings.” Confl Health 10(1): 31.



Health worker deployment systems

This study, conducted in northern Uganda and Zimbabwe, aimed 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. It explored policy and systems, and how and why they changed since the emergence from the crisis. It also assessed the impact of the key changes on staffing in rural and remote areas. All related resources are here with highlights below.


Mangwi Ayiasi, R., E. Rutebemberwa and T. Martineau (2019). ““Posting policies don’t change because there is peace or war”: the staff deployment challenges for two large health employers during and after conflict in Northern Uganda.” Human Resources for Health 17(1): 27.


Mashange, W., T. Martineau, P. Chandiwana, Y. Chirwa, V. M. Pepukai, S. Munyati and A. Alonso-Garbayo (2019). “Flexibility of deployment: challenges and policy options for retaining health workers during crisis in Zimbabwe.” Hum Resour Health 17(1): 39.



Effects of the 2014-16 Ebola outbreak on health workers in Sierra Leone

The ReBUILD team from COMAHS recognised a need to:


  • understand, from the health workers’ perspective, how the health system responded to the Ebola crisis,
  • to unpick the factors that supported or hindered health workers’ abilities to cope with the crisis, and
  • to generate findings that could be used to rebuild the post-Ebola health sector and during future epidemics.


The research found that several important coping strategies were used including those that drew upon existing mechanisms, and that supportive supervision, peer support networks and better use of communication technology should be pursued, alongside a programme for rebuilding trusting relations with community structures.


Raven, J., H. Wurie and S. Witter (2018). “Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study.” BMC health services research 18(1): 251.


Health workers’ remuneration in Sierra Leone

Devising the right incentive package for health workers is essential to improving their performance, but in many settings it is unclear what financial incentives are actually offered because of an understudied combination of payment sources. This research studied the nature and consequences of this situation in Sierra Leone, the results of which have contributed to the policy debate in Sierra Leone and in other post-conflict settings.


Bertone, M. P. and S. Witter (2015). “An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone.” Soc Sci Med 141: 56-63.


Health worker recruitment and deployment in Timor Leste

This study aimed to improve understanding of how recruitment and deployment policies, processes and practices contribute to effective health workforce coverage, including a gender and equity lens, after the conflict in Timor Leste.


The results of the work are presented in the paper ‘Understanding HRH recruitment in post-conflict settings: an analysis of central-level policies and processes in Timor-Leste (1999–2018)’,  and in this video Dr Alvaro Alonso-Garbayo discusses the work and its relevance.



Community health workers in fragile and conflict-affected settings.

This study, conducted in Sierra Leone, with smaller studies in Liberia and Democratic Republic of Congo, looked at how community health workers might be better supported to play an effective and long-term role in the broader health system in fragile contexts. Some of the results are presented in the brief, ‘Gender and Community Health Worker programmes in fragile and conflict-affected settings’, and in this video Dr Haja Wurie talks about the role of community health workers in Sierra Leone.


Raven, J., H. Wurie, A. Idriss, A. J. Bah, A. Baba, G. Nallo, K. K. Kollie, L. Dean, R. Steege, T. Martineau and S. Theobald (2020). “How should community health workers in fragile contexts be supported: qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo.” Human Resources for Health 18(1): 58.



Research products

ReBUILD’s resources relating to human resources for health are here.

Key findings from this research form the basis of a briefing paper, ‘Establishing a responsive and equitable health workforce post-conflict and post-crisis – lessons from ReBUILD research’ – read it here.


There’s more on the backgrounds to and outputs from each of ReBUILD’s research themes here:

"ReBUILD for Resilience brings together partners to share experiences, to discuss our contexts, and to create an appropriate model that helps build resilience in health systems across the country and beyond"

Sushil Baral, HERD International