Evolution of policies on human resources for health: opportunities and constraints in four post-conflict and post-crisis settings

Abstract

BackgroundFew studies look at policy making in the health sector in the aftermath of a conflict or crisis and even fewer specifically focus on Human Resources for Health, which is a critical domain for health sector performance. The main objective of the article is to shed light on the patterns and drivers of post-conflict policy-making. In particular, we explore whether the post -conflict period offers increased chances for the opening of ‘windows for opportunity’ for change and reform and the potential to reset health systems.MethodsThis article uses a comparative policy analysis framework. It is based on qualitative data, collected using three main tools - stakeholder mapping, key informant interviews and document reviews - in Uganda, Sierra Leone, Cambodia and Zimbabwe.ResultsWe found that HRH challenges were widely shared across the four cases in the post-conflict period but that the policy trajectories were different – driven by the nature of the conflicts but also the wider context. Our findings suggest that there is no formula for whether or when a ‘window of opportunity’ will arise which allows health systems to be reset. Problems are well understood in all four cases but core issues – such as adequate pay, effective distribution and HRH management – are to a greater or lesser degree unresolved. These problems are not confined to post-conflict settings, but underlying challenges to addressing them – including fiscal space, political consensus, willingness to pursue public objectives over private, and personal and institutional capacity to manage technical solutions – are liable to be even more acute in these settings. The role of the MoH emerged as weaker than expected, while the shift from donor dependence was clearly not linear and can take a considerable time.ConclusionsWindows of opportunity for change and reform can occur but are by no means guaranteed by a crisis – rather they depend on a constellation of leadership, financing, and capacity. Recognition of urgency is certainly a facilitator but not sufficient alone. Post-conflict environments face particularly severe challenges to evidence-based policy making and policy implementation, which also constrain their ability to effectively use the windows which are presented.

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

“…It was therefore part of a mixed methods study (Witter et al 2012). Similarly, in the deployment study data on transfer frequencies was also derived from a survey of personnel records (Martineau et al 2012), while the RInGS case studies also used key informant interviews and document review.…”

Results-based financing as a strategic purchasing intervention: some progress but much further to go in Zimbabwe?

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“…The public and private sectors entered survival modeshardly able to pay their staff and to continue to function. At this time, those with diverse sources of funding (such as municipalities, which are able to collect local taxes) were better able to reward and keep staff [16,20]. After the height of the crisis in 2008, the role of donors increased, providing resources in the recovery period after the formation of the Government of National Unity in 2009.…”

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