Human Resources for Health

“Posting policies don’t change because there is peace or war”

Paper by ReBUILD looking at how deployment policies and practices were adapted during the conflict and post-conflict periods in Acholi region, Uganda

Establishing a responsive & equitable health workforce post-conflict & post-crisis: lessons from ReBUILD research

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 it effectively post-conflict. This brief highlights some of the main findings on HRH and recommendations from ReBUILD’s research.

Establishing a responsive and equitable health workforce post-conflict and post-crisis – lessons from ReBUILD research

This brief outlines the findings from ReBUILD’s phase 1 research on health workers in post-conflict settings.

Les systèmes de santé pendant et après une crise : éléments probants en faveur de meilleures politiques et pratiques

Cette série de documents de synthèse, fruit des recherches menées par ReBUILD, aborde un nombre de questions clés concernant le renforcement des systèmes de santé dans les contextes affectés par un conflit ou une crise.

ReBUILD cross cutting and synthesis non peer-reviewed outputs

Summary of ReBUILD’s cross cutting and synthesis non peer-reviewed outputs, eg videos, briefs, infographics etc

Improving deployment of human resources for health in Zimbabwe in the context of crisis

This brief outlines key findings and recommendations from ReBUILD’s study of health worker deployment in Zimbabwe

Investigating results-based financing as a tool for strategic purchasing: comparing the cases of the Democratic Republic of Congo, Zimbabwe and Uganda

Presentation given by Maria Paula Bertone at a Satellite session of the 5th Global Symposium on Health Systems Reseach, on “Payment for Performance, how, why, where and what? Learning from research across income settings. Tuesday 9th October 2018.

Insights on health systems and community health workers from a photovoice project in Sierra Leone

This booklet presents the findings of a photovoice project into health systems and Community Health Workers in Sierra Leone

How gender infuences the service provided by Community Health Workers in Sierra Leone

This booklet presents the findings of a photovoice project into how gender infuences the service provided by Community Health Workers in Sierra Leone

Gender and community health worker programmes in fragile and conflict-affected settings. Findings from Sierra Leone, the Democratic Republic of Congo and Liberia

Based on findings from ReBUILD’s research project on community health workers in fragile and conflict-affected settings, this brief provides recommendations and guidance for practitioners and policy makers on the ways their workforce may be affected by gender norms, and actions to address them.

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

Alvaro Alonso-Garbayo speaks about understanding human resources for health recruitment and deployment in post-conflict settings

Video on a study into career progression amongst women in the post-conflict Cambodian health system

Sreytouch Vong on a study into career progression amongst women in the post-conflict Cambodian health system

Health worker deployment policies in conflict-affected northern Uganda

Richard Ayiasi Mangwi of ReBUILD talks about health worker deployment policies in conflict-affected northern Uganda

Health worker incentives in post-conflict Zimbabwe

Yotamu Chirwa of ReBUILD and Biomedical Training and Research Institute, Zimbabwe on health worker incentives in post-conflict Zimbabwe

Community health workers in Sierra Leone

Haja Wurie of ReBUILD and College of Medicine and Allied Health Sciences talks on community health workers in Sierra Leone. More on ReBUILD’s work on community health workers here.  

Supporting community health workers in fragile settings: evidence from Sierra Leone, Liberia and Democratic Republic of Congo

Poster presented at the Fifth Global Symposium on Health Systems Research in Liverpool in October 2018 on supporting community health workers in fragile settings

Summary of ReBUILD’s research themes, projects and outputs 2018

This summary of ReBUILD’s research projects from both the original phase and the short extension phase of the programme. It includes links to further information on the projects and their outputs.

Health Systems in Situations of Fragility

Presentation given by Professor Sophie Witter on 17th May 2018 for the American University of Beirut Global Health Institute’s Webinar series: “Global Health and Conflict”. This webinar theme: Health Systems in Situations of Fragility.

The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts

A paper from ReBUILD exploring the gendered experiences of health workers in fragile and post-conflict states

The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe

This 2013 paper examines implications for human resources for health of changes in user fees for maternal and newborn health services in Zimbabwe.

Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study

A paper from ReBUILD’s study on health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’ s health system.

What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal

ReBUILD paper examines health systems research that explored and evaluated health worker performance during crises in Sierra Leone & Nepal

Why do people become health workers? Analysis from life histories in four post‐conflict and post‐crisis countries

Paper from ReBUILD’s health worker incentives research looking at motivation to join the profession in Uganda, Sierra Leone, Cambodia & Zimbabwe.

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

Paper draws together lessons from ReBUILD’s research on health worker incentives in northern Uganda, Sierra Leone, Zimbabwe and Cambodia.

Resources from ReBUILD’s work on health financing in conflict-affected and post-conflict settings

Health financing in conflict-affected and post-conflict settings: Resources from ReBUILD’s work

Promoting women’s leadership in the post-conflict health sector in Cambodia

This brief describes findings from research conducted by RinGs and ReBUILD on women’s leadership in the health sector in Battambang province, Cambodia

Leaving no one behind: lessons on rebuilding health systems in conflict and crisis-affected states

This paper draws on ReBUILD’s research to understand key issues inhibiting health systems strengthening in fragile settings

Incentives for health workers to stay in post and in rural areas: findings from four conflict- and crisis-affected countries

ReBUILD report presents a cross-cutting analysis into health worker incentives in post-crisis northern Uganda, Sierra Leone, Cambodia & Zimbabwe

Experiences of using life histories with health workers in post-conflict and crisis settings: methodological reflections

This paper examines the ReBUILD programme’s experience of using life histories to explore health system trajectories coming out of conflict through the eyes of health workers. The paper shows how life histories with health staff can be a very powerful tool, particularly in contexts where routine data sources are absent or weak, and where health workers constitute a marginalized community.

Retention of health workers in rural Sierra Leone: findings from life histories

This article, published in Human Resources for Health, reports the findings from ReBUILD’s qualitative work in Sierra Leone on health worker incentives.

Health worker experiences of and movement between public and private not-for-profit sectors – findings from post-conflict Northern Uganda

This paper looks at the experiences of health workers during and after the 20 years of conflict in northern Uganda, and the factors that influenced their movement between public and private not-for-profit sectors. The findings highlight the need to ensure balanced health labour market incentives which take into account not only the changing context but also needs at different points in individuals’ life cycles and across all core service delivery sectors.

Understanding health worker incentives in post-crisis settings: lessons from health worker in-depth interviews and life histories in Zimbabwe

This is a report from the qualitative component of ReBUILD’s health worker incentives research in Zimbabwe, drawing on the ‘life histories’ interviews with health workers

Impact of user fees on health care seeking behaviour and financial protection during the crisis period in Zimbabwe: A life history approach

This report presents the findings and recommendations from part of ReBUILD’s qualitative health financing research in Zimbabwe, using the life histories approach.

Understanding deployment policies and systems for staffing rural areas in Northern Uganda during and after the conflict: synthesis report

This 2017 paper reports on ReBUILD’s research into deployment systems for health workers in remote and rural areas in Uganda

Health systems after conflict – evidence for better policy and practice

These briefs outline the main themes which have come from ReBUILD’s research, as well as an overview of the programme, its research projects, and how the themes developed from these.

Attraction and retention of Health Workers in Northern Uganda: Implications for faster reconstruction and Universal Coverage?

This brief outlines findings and recommendations from ReBUILD’s research on health worker incentives research in post-conflict northern Uganda, in support of universal health coverage.

Key messages from ReBUILD research in Uganda

This brief outlines the key messages which have come from ReBUILD’s research on health financing, health workforce and aid effectiveness in post-conflict northern Uganda

Learning from the experiences of health workers in conflict-affected Cambodia to improve motivation and retention: analysis of life histories

This 2016 ReBUILD working paper looks at the evolution of health worker incentives in Cambodia, Sierra Leone, Uganda and Zimbabwe

How to promote a resilient health workforce in conflict affected settings – insights from four countries

Combined presentations from a ReBUILD panel session at the 4th Global Symposium on Health Systems Research in Vancouver, Canada, on 18th November 2016

What do health workers do, and why? A study of the activities performed by primary healthcare workers in Sierra Leone

Poster from ReBUILD/LSHTM affiliate study on Health Workers’ Remuneration, Incentives and Accountability in Sierra Leone, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada

Outputs from the project Health Workers’ Remuneration, Incentives and Accountability in Sierra Leone

This page lists all outputs from the project Health Workers’ Remuneration, Incentives and Accountability in Sierra Leone

Why aren’t women rising to the top? Gender in Cambodia’s Health Workforce and Leadership

Poster from RinGs small grant project in Cambodia, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada

Data collection on rural posting /deployment of health workers in post crisis settings: A case of rural Zimbabwe

Poster from ReBUILD’s health worker deployment study in Zimbabwe, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada

Impact of the policy to freeze posts on the deployment of health workers after the crisis in rural Zimbabwe

Poster from ReBUILD’s health worker deployment study in Zimbabwe, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada

More flexibility in the use of deployment policies: the challenge of retaining health workers in post crisis settings in remote areas of Zimbabwe

Poster from ReBUILD’s health worker deployment study in Zimbabwe, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada Authors: Wilson Mashange, Yotamu Chirwa, Pamela Chandiwana, Mildred Pepukai, Shungu Munyati, Tim Martineau & Alvaro Alonso-Garbayo Click on the poster image to download the poster.

Adapting official deployment policies for staffing rural areas to build resilient health systems during conflict: lessons from northern Uganda

Poster from ReBUILD’s health worker deployment study in Uganda, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada.

Understanding factors that can promote resilience during and after economic crises: how to retain and motivate health workers at rural health facilities in Zimbabwe

Poster from ReBUILD’s health worker incentives study in Zimbabwe, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada.

Fostering development of sustainable incentive policies for a resilient health workforce: lessons from post crisis Zimbabwe

Poster from ReBUILD’s health worker incentives study in Zimbabwe, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada.

Building a resilient health system post Ebola: voices of health workers from Sierra Leone

Poster from ReBUILD’s study on health worker experiences of the Ebola outbreak in Sierra Leone, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada

Health worker experiences of and movement between public and private not-for-profit (PNFP) sectors in post conflict Northern Uganda: Lessons for health system resilience

Poster from ReBUILD’s health worker incentives study in Uganda, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada.

Resources from ReBUILD’s work on health worker incentives in Sierra Leone, and on health worker experiences during the Ebola outbreak

Details of all outputs from ReBUILD’s work on health worker incentives and remuneration in Sierra Leone, and on health worker experiences during the Ebola outbreak.

Resources from ReBUILD’s work on health worker incentives and deployment in post-conflict and post-crisis settings

This document includes details of all outputs from ReBUILD’s work on human resources for health in post-conflict and post-crisis settings.

‘Fighting a battle’: Ebola, health workers and the health system in Sierra Leone

A working paper on the ReBUILD study ‘Fighting a battle: Ebola, health workers and the health system in Sierra Leone’

Performance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone

The study investigates the absolute and relative contribution of performance-based financing (PBF) to health workers’ income and explores their views on PBF bonuses, in comparison to and interaction with other incomes. The study confirms the complex and interrelated nature of health workers’ remuneration and that the different financial incentives cannot be examined independently from one. It also shows that the way PBF schemes are implemented has an impact on health worker motivation.

Investigating health workers remuneration in Sierra Leone – preliminary results and reflections on methods

Presentation given by Maria Paola Bertone at the 3rd Conference of the African Health Economics and Policy Association (11-13 March, 2014, Nairobi).

Maintaining an effective health workforce during and after conflict: Evidence from ReBUILD’s research in northern Uganda

This research brief gives an overview and key findings/recommendations from ReBUILD’s research on health worker incentives in northern Uganda

Understanding health worker incentives in three districts of Zimbabwe: survey report

This 2015 report describes the findings from a health workers study in Zimbabwe which aimed to understand the incentive environment.

Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone

This 2016 ReBUILD paper investigates the formal and informal payments available to health workers in Sierra Leone

Increasing access to health services in remote and rural areas through improved retention of health workers: evidence from Sierra Leone

This 2014 poster describes a study on the effectiveness of incentive packages in attracting and retaining health workers in Sierra Leone

The challenges and opportunities of conducting ethical and trustworthy qualitative research in health systems in post-conflict and fragile contexts: Reflections from a learning community

ReBUILD poster presented at the Third Global Symposium on Health Systems Research in Cape Town 2014: A qualitative study exploring how to strengthen policy and practice related to health financing and human resource management in post conflict and fragile contexts

Equity in Maternal Health Care Services in post-conflict Northern and non-conflict East-Central Uganda: A Comparative Mixed Methods Multi-case study

ReBUILD poster presented at the Third Global Symposium on Health Systems Research in Cape Town 2014: Mixed method study comparing maternal health care in post-conflict and non-conflict regions of East Central Uganda

Mobility of health staff during conflict and post-conflict situations in a decentralized system, a case study of Northern Uganda

ReBUILD Poster presented at the Third Global Symposium on Health Systems Research in Cape Town 2014: Study to understand how the policy of recruitment and deployment under decentralization was implemented and its impact on mobility of health workers over the conflict and post-conflict periods

Health worker remuneration and incentive policies in post crisis Zimbabwe: challenges and Implications for retention of human resources for health

ReBUILD Poster presented at the Third Global Symposium on Health Systems Research in Cape Town 2014: The study examines how incentive environments have evolved during and after the crisis in Zimbabwe

Understanding health worker incentives in post-crisis settings: policies to attract and retain public health workers in Zimbabwe: key informant interviews

Report from key-informant interview element of ReBUILD’s research into health worker incentives environment in Zimbabwe.

Exploring the influence of context and policy on health district productivity in Cambodia

Despite gains in life expectancy and increased health expenditure, Cambodia still lags behind neighbours in many health indicators. This article aims to understand variations in efficiency of public health services, and the extent to which changes in efficiency are associated with key health policies that have been introduced to strengthen access to health services over the past decade.

Incentives to improve health workers’ retention and motivation: implementation challenges and informal practices at district level. The role of DHMTs and NGOs

This policy brief describes findings and gives recommendations from ReBUILD research on the actual implementation of policies on human resources for health at local level in Sierra Leone. The brief includes reflections on the challenges of translating knowledge not only into policy but also into effective practice. You can download the brief here.

Exploring the remuneration of primary healthcare workers: findings on incomes and income use strategies in Sierra Leone. What lessons can be learnt to design effective financial incentives?

This policy brief describes ReBUILD research to explore all of the financial incentives that make up health workers’ remuneration in Sierra Leone

Health workers’ incentives in post-conflict settings – a review of the literature and framework for research

This 2012 ReBUILD literature review identifies research gaps in relation to health worker incentives in post-conflict contexts.

The challenge of retaining health workers in Zimbabwe: findings from ReBUILD research

A briefing paper summarising the findings ReBUILD’s work on health worker incentives in ZImbabwe and giving policy recommendations

The challenge of retaining health workers in Zimbabwe: Implications for Universal Health Coverage

This 2015 brief focuses on ReBUILD’s work on the challenge of retaining health workers in Zimbabwe and implications for UHC

Research on health worker policies, incentives and retention in post-conflict countries: an overview of ReBUILD work

Presentations from ‘Evolution of policy and incentives for human resources for health post-conflict: learning from different contexts’ 2015

Evidence for supporting a skilled health workforce for all in Sierra Leone

This brief outlines ReBUILD’s research on health worker incentives in Sierra Leone, and gives recommendations for the post-Ebola recovery strategy, based on the research findings, focusing on the strand for in-creasing a skilled workforce, especially in under-served areas.

Haja Wurie speaks about Ebola in Sierra Leone

In this 2015 video Haja Wuried of the ReBUILD consortium shared her insights on post-Ebola health system reconstruction in Sierra Leone

Improving deployment systems for health workers in remote and rural areas: Project Protocol Summary

This document is a summary of the protocol for ReBUILD’s research on deployment systems for health workers in remote and rural areas. It details the approach used for this research in the two study countries. You can download the document here.

Understanding health worker incentives in post conflict settings: Project protocol summary

This document is a summary of the protocol for ReBUILD’s research on understanding health worker incentives in post-conflict settings. It details the approach used for this research across all four of the study countries. You can download the document here.

Financial incentives for human resources for health: What do we know? What do we do? The case of Sierra Leone

Abstract of an oral presentation given by Maria Paola Bertone at the “Health Services Research: Evidence-Based Practice” conference in July 2014

Performance-Based Financing in the context of the ‘complex remuneration’ of Health Workers – Findings from a mixed-methods study in rural Sierra Leone

Presentation by ReBUILD Affiliate researcher Maria Paola Bertone given at the International Health Economics Association Congress in Milan 15th July 2015

An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone

This 2015 ReBUILD paper focuses on health worker incentives and payments in Sierra Leone and presents an exploration of district-level implementation processes

Human resource management in post-conflict health systems: review of research and knowledge gaps

Effective human resource management strategies and policies are critical to addressing systemic effects of conflict on the health workforce. This paper reviews published literatures across three functional areas of HRM in post-conflict settings: workforce supply, workforce distribution, and workforce performance.

The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives

This paper argues that research focusing on the health workers’ “complex remuneration” is critical to address some of the most challenging issues affecting human resources for health. An empirical research agenda is proposed to fill the gap in our understanding.

Health worker incentives: survey report, Sierra Leone

A 2015 RBUILD report on the need to reach and maintain incentive environments for health workers to support access to equitable health services

A window of opportunity for reform? The case of policy on human resources for health in Sierra Leone after the conflict (2002-2012)

The study in this 2014 ReBUILD brief looks at the development of policies on human resources for health in Sierra Leone over the post-conflict decade

The Health Worker Incentives: Uganda Briefing

This 2013 ReBUILD brief summarises the findings from the life-histories approach used to explore health workers’ livelihoods and coping strategies in Uganda

Building a motivated health workforce – During and Post Ebola Outbreak in Sierra Leone

Drawing on ReBUILD’s research on health worker experiences and incentives in Sierra Leone, this briefing paper was produced to inform key actors involved in maintaining basic health services during the 2014-15 Ebola outbreak.

Health worker incentive environments during and postconflict

ReBUILD presentation from 2013 on early work on health worker incentive environments during and post-conflict

Country Situation Analysis Uganda

A REBUILD consortium Country Situation Analysis for Uganda from 2011

The free health care initiative: how has it affected health workers in Sierra Leone?

In this paper published in Health Policy and Planning, ReBUILD researchers Sophie Witter, Haja Wurie and Maria Bertone explore the effects and implications for health staff of Sierra Leone’s introduction in 2010 of the Free Health Care Initiative (FHCI).

Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems

This article presents the experiences of health workers who lived through decades of conflict in four districts of northern Uganda. It is based on in-depth interviews, using a life history approach, conducted as part of ReBUILD’s wider work on health workers’ experiences, motivation and incentives during and after conflict.

Understanding health worker incentives in post-crisis settings – a document review of Zimbabwe

A 2014 ReBUILD report on health worker incentives in post-crisis settings: policies to attract and retain health workers in rural Zimbabwe

The Free Health Care Initiative: how has it affected health workers in Sierra Leone

This 2014 ReBUILD report pulls together findings relating to the Free Health Care Initiative (FHCI), as part of ReBUILD’s wider research on the evolution of incentives for health workers in post-conflict Sierra Leone.

Staffing the public health sector in Sierra Leone, 2005‐11: findings from routine data analysis

A 2014 ReBUILD report on staffing the public health sector in Sierra Leone, 2005‐11: findings from routine data analysis

Policies to attract and retain health workers in Northern Uganda during and after conflict: findings of key informant interviews

A 2014 ReBUILD report on policies to attract and retain health workers in Northern Uganda during and after conflict

The development of HRH policy in Sierra Leone, 2002-2012 – report on key informant interviews

A ReBUILD consortium report on the he development of humna resources for health policy in Sierra Leone, 2002-2012

Serving through and after conflict: life histories of health workers in Sierra Leone

This 2014 ReBUILD study in Sierra Leone used a life history approach to explore health workers’ experiences over time

Health workers career paths livelihoods and coping strategies in conflict and post conflict Uganda

Report of ReBUILD’s ‘life history’ study of serving health workers in four districts of the Acholi sub-region in northern Uganda, as part of ReBUILD’s wider work on health worker experiences and incentives during and after conflict.