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

Abstract

Introduction: Life history is a research tool which has been used primarily in sociology and anthropology to document experiences of marginalized individuals and communities. It has been less explored in relation to health system research. In this paper, we examine our experience of using life histories to explore health system trajectories coming out of conflict through the eyes of health workers. Methods: Life histories were used in four inter-related projects looking at health worker incentives, the impact of Ebola on health workers, deployment policies, and gender and leadership in the health sector. In total 244 health workers of various cadres were interviewed in Uganda, Sierra Leone, Zimbabwe and Cambodia. The life histories were one element within mixed methods research. Results: We examine the challenges faced and how these were managed. They arose in relation to gaining access, data gathering, and analysing and presenting findings from life histories. Access challenges included lack of familiarity with the method, reluctance to expose very personal information and sentiments, lack of trust in confidentiality, particularly given the traumatized contexts, and, in some cases, cynicism about research and its potential to improve working lives. In relation to data gathering, there was variable willingness to draw lifelines, and some reluctance to broach sensitive topics, particularly in contexts where policy-related issues and legitimacy are commonly still contested. Presentation of lifeline data without compromising confidentiality is also an ethical challenge. Conclusion: We discuss how these challenges were (to a large extent) surmounted and conclude that 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 (as is often the case for mid-level cadres, those serving in remote areas, and staff who have lived through conflict and crisis).

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

“…Our findings on the HRH challenges faced in these four setting are consistent with one another and with the wider literature [5, 40, 41]. As a result of conflict and crisis, the number of health workers diminishes because of death and migration and additionally health workers are likely to move to the more secure or economically stable areas, therefore increasing the unbalanced distribution within the country.…”

“…Their productivity also decreases because of absenteeism, poor working conditions, unavailability of drugs and equipment, low salaries and demotivation. Often, given the weaknesses or absence of regulation and control, health workers put in place a series of financial coping strategies which further weaken their performance and the health system, including dual practice, both in the health sector (private practice or work for NGOs and aid agencies) and outside [40]. …”

WITHDRAWN: Experience and reflections of using individual work histories and events of public sector doctors to unpack Human Resource Management policies and systems: Job histories as powerful method in Human Resource for Health research

“…Job histories have been defined as "when the focus of the interview is the subject's career or professional trajectory and main work-related events they are referred to as work histories" (8). Job or 'work' histories have been used in disciplines such as hospitality (9), labour market analysis (10) and health sector, more specifically occupational and environmental health (11,12).…”

Why do people become health workers?Analysis from life histories in 4 post‐conflict and post‐crisis countries

“…Amongst other projects, we examined changing incentive environments for health workers . Many fragile and conflict‐affected states struggle to maintain an adequate and balanced health workforce . Within this project, we used life histories to examine the experiences of health workers during different phases of their career and their country's history.…”

“…9 Many fragile and conflict-affected states struggle to maintain an adequate and balanced health workforce. 10,11 Within this project, we used life histories to examine the experiences of health workers during different phases of their career and their country's history. Different themes emerged, including motivation to join the health profession.…”