Join our #HSRFCAS Twitter chat! Health workforce strengthening in fragile and conflict affected states

By Natasha Salaria, Journal Development Editor at BioMed Central

The “Filling the void: Health systems in fragile and conflict affected states” series is an initiative of Conflict and Health, in collaboration with the Thematic Working Group on Health Systems in Fragile and Conflict Affected States.

Healthcare in fragile and conflict affected states remains critical and this series aims to provide evidence on health policies and programmes that work in fragile or conflict-affected situations. The series launched in November and has a growing range of articles touching on various aspects of health systems in fragile and conflict affected states.

In recognition of the ‘Filling the void’ series @Conflict_Health will be hosting a 1 hour Twitter-chat to discuss human resources for health  – one of the key pillars of health systems – based on these papers from the series:

Community health workers of Afghanistan: a qualitative study of a national program

Engaging frontline health providers in improving the quality of health care using facility-based improvement collaboratives in Afghanistan: case study

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

A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002–2012

Questions for discussion during the Tweet chat are:

  1. Why is strengthening the health workforce so important in FCAS (fragile and conflict affected states)? #HSRFCAS
  2. What particular role is there for close-to-community workers e.g. community health workers #HSRFCAS
  3. What do we know about what needs to be done to strengthen the workforce in this context? What are the knowledge gaps? #HSRFCAS
  4. What windows of opportunity are there for strengthening the health workforce in conflict and post-conflict states? #HSRFCAS
  5. What things can be done to ensure health systems are adequately staffed in times of conflict? #HSRFCAS

For a chance to have your say, join us @Conflict_Health and the prominent group of researchers involved in the discussion Tim Martineau (@TimMartineau), Suzanne Fustukian (@IIHD_QMU), and Maria Bertone (@mpbertone) on 6 February 2015 at 16:00 UK Time.

If you are not able to attend the live discussion, please feel free to tweet your comments to @Conflict_Health using the hashtag #HSRFCAS. An edited summary of the Twitter chat will be published in a Storify post shortly after the session.

If you haven’t done so yet, we also invite you to join our LinkedIn group, where more discussions on the topic on health systems research in fragile and conflict affected states take place.

We look forward to your participation!

What can we learn from health policy making patterns in post-conflict Sierra Leone for post-Ebola times?

By Kate Hawkins

I am a big fan of the IHP newsletter. It lands in the email every Friday and never fails to provide something to make you think, laugh, or get irritated. The editorials by Kristof Decoster are a must read and you can follow him on Twitter. What more could you ask for?

So a huge thanks to the IHP newsletter team for highlighting a blog by our colleague  last week. She argues that:

One of the unresolved challenges in post-crisis settings is the balance between humanitarian aid and the longer-term development approach to rebuilding the health system. We agree that decisions made in the early recovery phase could determine the long term development of the health system. But how, when, why and by whom are those decisions made? We know surprisingly little about that.

Drawing on evidence from a recent paper in Conflict and Health she outlines what happened with human resources for health reforms in Sierra Leone, from the end of the conflict in 2002 until 2012, and suggests some lessons that other countries can learn.

You can read all about it on the IHP website…

And subscribe to the newsletter, you won’t regret it!

NEW! Brief on post-conflict reform in Sierra Leone

One of the challenges when a conflict is over is the balance between emergency aid to save lives and a longer-term approach based on rebuilding the health system. Some researchers believe that the decisions taken shortly after a conflict can influence how the health system will develop and that a political “window of opportunity” for reform exists at this time. To test these two concepts and to understand how reform takes place, it is helpful to analyse how, when and why policy is made after conflict. In order to do this, the ReBUILD Consortium focused on the factors shaping policy on human resources for health in Sierra Leone after the war had ended in 2002. The findings are published in an article which begins by setting the context of the health system in Sierra Leone before the war; explains the methods used to collect information for the study and the difficulties encountered, and looks at how policy on health workers was made from 2002 to 2012. Three stages in policy-making are identified and discussed in detail. The article concludes that decisions taken early on after the war in Sierra Leone did have an impact on the development of human resources for health policy and ultimately the health system. However, the window of opportunity for reform did not open immediately after the end of the conflict but eight years afterwards when a key initiative came into force which introduced free health care at the point of delivery, for mothers and children. This event – propelled by increased political will from high-ranking government officials as well as international pressure and support – sparked off major changes throughout the health system.

Read the brief

“Windows of opportunity” for health systems post-conflict: Quick update from Cape Town

By Tim Martineau, Liverpool School of Tropical Medicine

I am a member of the Global Health Workforce Alliance’s Technical Working Group on Fragile States, and on Monday morning in the Global Symposium session on ‘Re-energizing the human resources for health (HRH) agenda for a post-2015 world: Priorities for HRH research’ we discussed “windows of opportunity” in the post-conflict period.

It was a topic that re-emerged in a meeting of the Thematic Working Group (TWG) on Health Systems in Fragile and Conflict Affected States. Sophie Witter’s presentation was of her paper, “A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone,” from the special issue of Conflict and Health organised by the TWG.  In the case of HRH policy in Sierra Leone, Sophie reported that the window of opportunity did not open in the immediate post-conflict period, but rather eight years later when the Free Health Care Initiative was announced.  Panel member Anne Cavanan, Director of Health Policy and Practice, International Medical Corps, commented on the poverty of health systems research in fragile and conflict affected contexts and welcomed the contribution by Sophie and colleagues.  She added that we should also be trying to help ministries of health to document processes from the immediate post-conflict period and to become learning organisations.

How to protect health workers in conflicts and crisis

Recruiting health workers with high levels of internal motivation is critical for work in difficult conditions, where their personal security and health might be compromised, according to new research published today in Health Policy and Planning.

Health workers often witness the deaths of friends and colleagues during conflict situations and also face abduction, injury and death, themselves. Life history interviews with 26 health workers who lived through conflict in Northern Uganda reveal their resilience and how they coped by building trusting relationships with the community, seeking support from managers and elders, and finding strength from their faith and commitment to serve their community.

Namakula and Witter propose the following solutions to help protect and keep staff motivated during and after times of crisis, when they are likely to feel disconnected from social and professional support systems, lack supplies and face an increased work load with limited pay and personal insecurity:

* Community support

* Appreciation by supervisors

* Effective working conditions

* The opportunity to learn and develop new skills

* Formal promotion and recognition of their contributions in a dangerous situation

* Employment benefits such as food, accommodation, transport and free healthcare

* Good leadership and communication in the workplace

* Regular and adequate pay

* Flexible working and inclusive management

This research was carried out at Makerere University and Queen Margaret University with support from the UK Department for International Development through the ReBUILD Consortium. Justine Namakula, ReBUILD Research Fellow at the School of Public Health, Makerere: “This research helps us to understand the lived experience of health workers during and after conflict in Northern Uganda and how policy-makers can protect and motivate them”

The study is part of the ReBUILD health worker incentives research project, which aims to understand the evolution of incentives for health workers after conflict and propose policy recommendations to improve health worker retention. Recruitment, retention and management of health workers can be challenging worldwide but is exacerbated in conflict situations and fragile states. In previous research on conflict and fragile states the perspectives of health workers on the front-line has often been overlooked but they are crucial to improving policies and providing effective health services. The Acholi sub-region of Northern Uganda experienced violent conflict as a result of fighting between the government and the Lord’s Resistance Army for 20 years, between 1986 and 2006. During the conflict, the health system was split into two, a camp-based system run by international agencies and NGOs, and a health service provided by the government in towns.

This article describes the experience of health workers who had lived through the conflict in the Acholi sub-region, explaining how they coped and what motivated them to stay. It is published as part of a special supplement on the ‘science and practice of people-centred health systems’, the theme of the Third Global Symposium on Health Systems Research, currently taking place in Cape Town, South Africa.

Notes Health Policy and Planning is a peer reviewed, optional open access journal publishing high quality research and original ideas relevant to the design, implementation and evaluation of health policies in low and middle-income countries. The Journal is jointly published by the London School of Hygiene and Tropical Medicine and Oxford University Press.

For more information or to request interviews contact Mandip Aujla, If you wish to provide a link to the free abstract of this paper for your readers, please use the following,

Full reference: 1. Namakula, J. and Witter, S. Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems. Health Policy and Planning 2014; 29: ii6-ii14. 2. This research was carried out with the support of the ReBUILD Consortium and was published as part of a supplement launching on Thursday 2nd October at the Third Global Symposium on Health Systems Research, Cape Town.

NEW PUBLICATION: Report from the consultation on Collaboration for Applied Health Research and Delivery

The Centre for Applied Health Research and Delivery (CAHRD) is an international network that combines individuals, disciplines and organisations based at the Liverpool School of Topical Medicine in the UK. Earlier in the year they held a far reaching consultation in order to shape their work over the next 20 years. It focused on; lung health, maternal and newborn health, Neglected Tropical Diseases, and health systems. One of the aims of the consultation was to find synergies between these different areas.

Work in fragile and conflict affected settings was a prominent theme in the consultation and ReBUILD researchers participated in the dialogue. These conversations have been written up for a new paper in the journal Conflict and Health. The article addresses issues like:

  • Human resources for health from the perspective of IPASC in rural Democratic Republic of Congo
  • The health systems challenges in addressing Neglected Tropical Diseases
  • The role of intersectoral action in strengthening health systems
  • Future directions of health system strengthening in fragile and conflict affected settings

Read the full paper ‘Fragile and conflict affected states: report from the consultation on Collaboration for Applied Health Research and Delivery’

If you are interested in discussions related to the Centre you can follow Bertie Squire on Twitter.

Photo of our colleague Sarah Ssali taking a well earned coffee break at the consultation, courtesy of Matt Goodfellow.