NEW! Brief on managing the health workforce after a conflict: a review of research and knowledge gaps

During conflict, health systems can break down, with clinics and hospitals destroyed and medicine in short supply, leaving people at high risk of disease. Health workers can be targets and many leave the conflict zone. Managing human resources well can help overcome shortages in the health workforce, as well as other challenges such as workers’ skills which do not match health service needs, patchy human resource data, inadequate medical training and weak management. This area is complex, and understanding how human resource management (HRM) contributes to rebuilding health systems after conflict is valuable. The knowledge can be used to inform national and international policy-makers: this is important as decisions made immediately after a conflict can influence the development of the health system in the long term.

Research in this field is, however, limited, with few reviews providing an overview of the evidence. Therefore the ReBUILD consortium has carried out a review of publications in the area of HRM in health systems in countries affected by conflict. It was structured using a framework which looks at three areas of the health workforce: supply, distribution and performance, as well as some overlapping areas, such as finance and gender. We know most about workforce supply issues, such as training, pay and recruitment, but less about workforce distribution and performance. The review stresses the need for more primary research, with a longer term perspective. Further research will increase awareness of how effective HRM can develop the health workforce and help build strong health systems after conflict has ended.

Read the brief!

Photo courtesy of ICRC/C. Martin-Chico/

Health systems and gender in post-conflict contexts: building back better?

If you haven’t seen it  yet you might want to check out ‘Filling the void: Health systems in fragile and conflict affected states’ a special issue of the journal Conflict and Health. ReBUILD authors have contributed papers to this series. The most recent one is an analysis of gender in health system reconstruction. The authors – Valerie Percival, Esther Richards, Tammy MacLean and Sally Theobald – explain:

The post-conflict or post-crisis period provides the opportunity for wide-ranging public sector reforms: donors fund rebuilding and reform efforts, social norms are in a state of flux, and the political climate may be conducive to change. This reform period presents favourable circumstances for the promotion of gender equity in multiple social arenas, including the health system. As part of a larger research project that explores whether and how gender equity considerations are taken into account in the reconstruction and reform of health systems in conflict-affected and post conflict countries, we undertook a narrative literature review based on the questions “How gender sensitive is the reconstruction and reform of health systems in post conflict countries, and what factors need to be taken into consideration to build a gender equitable health system?” We used the World Health Organisation’s (WHO) six building blocks as a framework for our analysis; these six building blocks are: 1) health service delivery/provision, 2) human resources, 3) health information systems, 4) health system financing, 5) medical products and technologies, and 6) leadership and governance.The limited literature on gender equity in health system reform in post conflict settings demonstrates that despite being an important political and social objective of the international community’s engagement in conflict-affected states, gender equity has not been fully integrated into post-conflict health system reform. Our review was therefore iterative in nature: To establish what factors need to be taken into consideration to build gender equitable health systems, we reviewed health system reforms in low and middle-income settings. We found that health systems literature does not sufficiently address the issue of gender equity. With this finding, we reflected on the key components of a gender-equitable health system that should be considered as part of health system reform in conflict-affected and post-conflict states. Given the benefits of gender equity for broader social and economic well-being, it is clearly in the interests of donors and policy makers to address this oversight in future health reform efforts.

Read the full paper…

Photo courtesy of Sojoud Elgarrai – UNAMID


Maternity ward at Princess Christian Maternal Hospital

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

We’ve been busy, working with others, on a Special Issue of Conflict and Health. More papers will be coming soon, so watch this space. In this article Maria Paola Bertone, Mohamed Samai, Joseph Edem-Hotah and Sophie Witter examined features of the post-conflict policy-making environment in Sierra Leone. The study looked at the development of policies on human resources for health (HRH) over the decade after the conflict (2002–2012).

What did they find?

At first policy making was characterized by political uncertainty, incremental policies and stop-gap measures. However, the context substantially changed in 2009. The launch of the Free Health Care Initiative was an instrumental event and catalyst for health system, and human resource policy, reform. However, after the launch of the initiative, the pace of decision-making again slowed down. The key drivers of human resources policy in Sierra Leone were: (i) the political situation, at first uncertain and later on more defined; (ii) the availability of funding and the stances of agencies providing such funds; (iii) the sense of need for radical change – which is perhaps the only element related to the post-conflict setting. It also emerges that a ‘windows of opportunity’ for reform did not open in the immediate post-conflict, but rather 8 years later when the Free Health Care Initiative was announced, thus making it difficult to link it directly to the features of the post-conflict policy-making environment.

What next?

We suggest that you read the whole paper, which is open access and free to download. You can find it on the Conflict and Health website.

The image in this blog is of the maternity ward at Princess Christian Maternal Hospital. The copyright belongs to Amnesty International.