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Onvlee O, Kok M, Buchan J, Dieleman M, Hamza M, Herbst C. Human Resources for Health in Conflict Affected Settings: A Scoping Review of Primary Peer Reviewed Publications 2016-2022. Int J Health Policy Manag 2023; 12:7306. [PMID: 38618826 PMCID: PMC10590254 DOI: 10.34172/ijhpm.2023.7306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/20/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Conflict has devastating effects on health systems, especially on healthcare workers (HCWs) working in under-resourced and hostile environments. However, little evidence is available on how policy-makers, often together with development partners, can optimize the organization of the health workforce and support HCWs to deliver accessible and trustworthy health services in conflict-affected settings (CAS). METHODS A scoping review was conducted to review recent evidence (2016-2022) on human resources for health (HRH) in CAS, and critically discuss HRH challenges in these settings. Thirty-six studies were included in the review and results were presented using an adapted version of the health labour market (HLM) framework. RESULTS Evidence from CAS highlights that conflict causes specific constraints in both the education sector and in the HLM, and deepens any existing disconnect between those sectors. Parallel and inadequate education and performance management systems, attacks on health facilities, and increased workload and stress, amongst other factors, affect HCW motivation, performance, distribution, and attrition. Short-term, narrowly focused policy-making undermines the long-term sustainability and resilience of the health workforce in CAS, and also contributes to the limited and narrow available research base. CONCLUSION While HRH and workforce issues in CAS include those found in many other low- and middle-income countries (LMICs), an additional set of challenges for HCWs, governance dynamics and institutional constraints in CAS 'multiply' negative effects on the health workforce. HRH policies, programmes and interventions must be aligned with the political and broader societal context, including the stage, severity and other dynamics of conflict. During conflict, it is important to try to monitor in- and outflow of HCWs and provide HCWs the support they need at local level or through remote measures. The post-conflict situation may present opportunities for improvement in HRH, but a clear understanding of political economy dynamics is required to better act on any such a window of opportunity.
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Affiliation(s)
- Olivier Onvlee
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Maryse Kok
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - James Buchan
- Faculty of Health, WHO Collaborating Centre, University of Technology, Sydney, NSW, Australia
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Mavragani A, Al Nsour M, Alonso-Garbayo A, Al Serouri A, Maiteh A, Badr E. Health System Resilience in the Eastern Mediterranean Region: Perspective on the Recent Lessons Learned. Interact J Med Res 2022; 11:e41144. [PMID: 36480685 PMCID: PMC9795408 DOI: 10.2196/41144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Public health has a pivotal role in strengthening resilience at individual, community, and system levels as well as building healthy communities. During crises, resilient health systems can effectively adapt in response to evolving situations and reduce vulnerability across and beyond the systems. To engage national, regional, and international public health entities and experts in a discussion of challenges hindering achievement of health system resilience (HSR) in the Eastern Mediterranean Region, the Eastern Mediterranean Public Health Network (EMPHNET) held its seventh regional conference in Amman, Jordan, between November 15 and 18, 2021, under the theme "Towards Resilient Health Systems in the Eastern Mediterranean: Breaking Barriers." This viewpoint paper portrays the roundtable discussion of experts on the core themes of that conference. OBJECTIVE Our aim was to provide insights on lessons learned from the past and explore new opportunities to attain more resilient health systems to break current barriers. METHODS The roundtable brought together a panel of public health experts representing Field Epidemiology Training Programs (FETPs), Centers for Disease Control and Prevention in Atlanta, World Health Organization, EMPHNET, universities or academia, and research institutions at regional and global levels. To set the ground, the session began with four 10-12-minute presentations introducing the concept of HSR and its link to workforce development with an overall reflection on the matter and lessons learned through collective experiences. The presentations were followed by an open question and answer session to allow for an interactive debate among panel members and the roundtable audience. RESULTS The panel discussed challenges faced by health systems and lessons learned in times of the new public health threats to move toward more resilient health systems, overcome current barriers, and explore new opportunities to enhance the HSR. They presented field experiences in building resilient health systems and the role of FETPs with an example from Yemen FETP. Furthermore, they debated the lessons learned from COVID-19 response and how it can reshape our thinking and strategies for approaching HSR. Finally, the panel discussed how health systems can effectively adapt and prosper in the face of challenges and barriers to recover from extreme disruptions while maintaining the core functions of the health systems. CONCLUSIONS Considering the current situation in the region, there is a need to strengthen both pandemic preparedness and health systems, through investing in essential public health functions including those required for all-hazards emergency risk management. Institutionalized mechanisms for whole-of-society engagement, strengthening primary health care approaches for health security and universal health coverage, as well as promoting enabling environments for research, innovation, and learning should be ensured. Investing in building epidemiological capacity through continuous support to FETPs to work toward strengthening surveillance systems and participating in regional and global efforts in early response to outbreaks is crucial.
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Affiliation(s)
| | - Mohannad Al Nsour
- Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
| | | | | | - Adna Maiteh
- Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
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Lokot M, Bou-Orm I, Zreik T, Kik N, Fuhr DC, El Masri R, Meagher K, Smith J, Asmar MK, McKee M, Roberts B. Health System Governance in Settings with Conflict-Affected Populations: A Systhematic Review. Health Policy Plan 2022; 37:655-674. [PMID: 35325120 DOI: 10.1093/heapol/czac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Health system governance has been recognised as critical to strengthening healthcare responses in settings with conflict-affected populations. The aim of this review was to examine existing evidence on health system governance in settings with conflict-affected populations globally. The specific objectives were: (i) to describe the characteristics of the eligible studies; (ii) to describe the principles of health system governance; (iii) to examine evidence on barriers and facilitators for stronger health system governance; and (iv) to analyse the quality of available evidence. A systematic review methodology was used following PRISMA criteria. We searched six academic databases, and used grey literature sources. We included papers reporting empirical findings on health system governance among populations affected by armed conflict, including refugees, asylum seekers, internally displaced populations, conflict-affected non-displaced populations and post-conflict populations. Data were analysed according to the study objectives and informed primarily by the Siddiqi et al. (2009) governance framework. Quality appraisal was conducted using an adapted version of the Mixed Methods Appraisal Tool. Of the 6,511 papers identified through database searches, 34 studies met eligibility criteria. Few studies provided a theoretical framework or definition for governance. The most frequently identifiable governance principles related to participation and coordination, followed by equity and inclusiveness and intelligence and information. The least frequently identifiable governance principles related to rule of law, ethics and responsiveness. Across studies, the most common facilitators of governance were collaboration between stakeholders, bottom-up and community-based governance structures, inclusive policies, and longer-term vision. The most common barriers related to poor coordination, mistrust, lack of a harmonised health response, lack of clarity on stakeholder responsibilities, financial support, and donor influence. This review highlights the need for more theoretically informed empirical research on health system governance in settings with conflict-affected populations that draws on existing frameworks for governance.
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Affiliation(s)
- Michelle Lokot
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Ibrahim Bou-Orm
- Saint Joseph University of Beirut, B.P. 11-5076 Riad El Solh, Beyrouth 1107 2180, Lebanon
| | - Thurayya Zreik
- War Child Holland, Verdun, Hussein Oweini street, Beirut, Lebanon
| | - Nour Kik
- Ministry of Public Health, Lebanese University Central Directorate, 4th Floor, Museum Square, Beirut 9800, Lebanon
| | - Daniela C Fuhr
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Rozane El Masri
- War Child Holland, Verdun, Hussein Oweini street, Beirut, Lebanon
| | | | - James Smith
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
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Sriram V, Hariyani S, Lalani U, Buddhiraju RT, Pandey P, Bennett S. Stakeholder perspectives on proposed policies to improve distribution and retention of doctors in rural areas of Uttar Pradesh, India. BMC Health Serv Res 2021; 21:1027. [PMID: 34587959 PMCID: PMC8478638 DOI: 10.1186/s12913-021-06765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background In India, the distribution and retention of biomedical doctors in public sector facilities in rural areas is an obstacle to improving access to health services. The Government of Uttar Pradesh is developing a comprehensive, ten-year Human Resources for Health (HRH) strategy, which includes policies to address rural distribution and retention of government doctors in Uttar Pradesh (UP). We undertook a stakeholder analysis to understand stakeholder positions on particular policies within the strategy, and to examine how stakeholder power and interests would shape the development and implementation of these proposed policies. This paper focuses on the results of the stakeholder analysis pertaining to rural distribution and retention of doctors in the government sector in UP. Our objectives are to 1) analyze stakeholder power in influencing the adoption of policies; 2) compare and analyze stakeholder positions on specific policies, including their perspectives on the conditions for successful policy adoption and implementation; and 3) explore the challenges with developing and implementing a coordinated, ‘bundled’ approach to strengthening rural distribution and retention of doctors. Methods We utilized three forms of data collection for this study – document review, in-depth interviews and focus group discussions. We conducted 17 interviews and three focus group discussions with key stakeholders between September and November 2019. Results We found that the adoption of a coordinated policy approach for rural retention and distribution of doctors is negatively impacted by governance challenges and fragmentation within and beyond the health sector. Respondents also noted that the opposition to certain policies by health worker associations created challenges for comprehensive policy development. Finally, respondents believed that even in the event of policy adoption, implementation remained severely hampered by several factors, including weak mechanisms of accountability and perceived corruption at local, district and state level. Conclusion Building on the findings of this analysis, we propose several strategies for addressing the challenges in improving access to government doctors in rural areas of UP, including additional policies that address key concerns raised by stakeholders, and improved mechanisms for coordination, accountability and transparency. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06765-x.
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Affiliation(s)
- Veena Sriram
- University of British Columbia, School of Public Policy and Global Affairs and School of Population and Public Health, C. K. Choi Building, 251 - 1855 West Mall B.C, Vancouver, V6T 1Z2, Canada.
| | - Shreya Hariyani
- Johns Hopkins Bloomberg School of Public Health, Ratan Square, Vidhan Sabha Marg, Lucknow, Uttar Pradesh, India
| | - Ummekulsoom Lalani
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Ravi Teja Buddhiraju
- Uttar Pradesh Technical Support Unit, India Health Action Trust, Ratan Square, Vidhan Sabha Marg, Lucknow, Uttar Pradesh, India
| | - Pooja Pandey
- Indian Administrative Service, Lucknow, Uttar Pradesh, India
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
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Ayaz B, Martimianakis MA, Muntaner C, Nelson S. Participation of women in the health workforce in the fragile and conflict-affected countries: a scoping review. HUMAN RESOURCES FOR HEALTH 2021; 19:94. [PMID: 34348739 PMCID: PMC8336014 DOI: 10.1186/s12960-021-00635-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/22/2021] [Indexed: 05/29/2023]
Abstract
INTRODUCTION AND BACKGROUND The full participation of women as healthcare providers is recognized globally as critical to favorable outcomes at all levels, including the healthcare system, to achieving universal health coverage and sustainable development goals (SDGs) by 2030. However, systemic challenges, gender biases, and inequities exist for women in the global healthcare workforce. Fragile and conflict-affected states/countries (FCASs) experience additional pressures that require specific attention to overcome challenges and disparities for sustainable development. FCASs account for 42% of global deaths due to communicable, maternal, perinatal, and nutritional conditions, requiring an appropriate health workforce. Consequently, there is a need to understand the impact of gender on workforce participation, particularly women in FCASs. METHODS This scoping review examined the extent and nature of existing literature, as well as identified factors affecting women's participation in the health workforce in FCASs. Following Arksey and O'Malley's scoping review methodology framework, a systematic search was conducted of published literature in five health sciences databases and grey literature. Two reviewers independently screened the title and abstract, followed by a full-text review for shortlisted sources against set criteria. RESULTS Of 4284, 34 sources were reviewed for full text, including 18 primary studies, five review papers, and 11 grey literature sources. In most FCASs, women predominate in the health workforce, concentrated in nursing and midwifery professions; medicine, and the decision-making and leadership positions, however, are occupied by men. The review identified several constraints for women, related to professional hierarchies, gendered socio-cultural norms, and security conditions. Several sources highlight the post-conflict period as a window of opportunity to break down gender biases and stereotypes, while others highlight drawbacks, including influences by consultants, donors, and non-governmental organizations. Consultants and donors focus narrowly on programs and interventions solely serving women's reproductive health rather than taking a comprehensive approach to gender mainstreaming in planning human resources during the healthcare system's restructuring. CONCLUSION The review identified multiple challenges and constraints facing efforts to create gender equity in the health workforce of FCASs. However, without equal participation of women in the health workforce, it will be difficult for FCASs to make progress towards achieving the SDG on gender equality.
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Affiliation(s)
- Basnama Ayaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
| | - Maria Athina Martimianakis
- Department of Paediatrics and Scientist, Wilson Centre for research in health professions education, Temerty Faculty of Medicine, University of Toronto, ON 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Sioban Nelson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
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Wong A, Hung KKC, Mabhala M, Tenney JW, Graham CA. Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158132. [PMID: 34360423 PMCID: PMC8346012 DOI: 10.3390/ijerph18158132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022]
Abstract
Background: While the pharmacy workforce is the third largest professional healthcare group worldwide, the pharmacy workforce landscape remains unclear in post-conflict areas in sub-Saharan Africa. Method: Key informants were selected for semi-structured interviews due to their role in providing pharmacy services in the selected country: the Central African Republic (CAR), the Democratic Republic of Congo (DRC), Ethiopia, and South Sudan. Transcripts from the interviews were anonymized, coded, and analyzed. Results: Nine participants were recruited (CAR: 2; DRC: 2; Ethiopia: 2; South Sudan: 3), and all except two were pharmacists. Conflict-specific challenges in pharmacy service delivery were identified as the following: unpredictable health needs and/or mismatched pharmaceutical supply, transport difficulties due to insecure roads, and shortage of pharmacy workforce due to brain drain or interrupted schooling. Barriers to health workforce retention and growth were identified to be brain drain as a result of suboptimal living and working conditions or remuneration, the perception of an unsafe work environment, and a career pathway or commitment duration that does not fit the diaspora or expatriate staff. Conclusion: To tackle the barriers of pharmacy health workforce retention and growth, policy solutions will be required and efforts that can bring about long-term improvement should be prioritized. This is essential to achieve universal health coverage and the targets of the sustainable development goals for conflict affected areas, as well as to “leave no one behind”.
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Affiliation(s)
- Anabelle Wong
- The Institute of Public Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
- Max Planck Institute for Infection Biology, 10117 Berlin, Germany
| | - Kevin K. C. Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China;
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence:
| | - Mzwandile Mabhala
- Department of Public Health and Wellbeing, University of Chester, Chester CH1 4BJ, UK;
| | - Justin W. Tenney
- School of Pharmacy, West Coast University, Los Angeles, CA 92617-3040, USA;
| | - Colin A. Graham
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, China;
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
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Rayes D, Meiqari L, Yamout R, Abbara A, Nuwayhid I, Jabbour S, Abouzeid M. Policies on return and reintegration of displaced healthcare workers towards rebuilding conflict-affected health systems: a review for The Lancet-AUB Commission on Syria. Confl Health 2021; 15:36. [PMID: 33962634 PMCID: PMC8103581 DOI: 10.1186/s13031-021-00367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
Background War and armed conflicts severely disrupt all health system components, including the healthcare workforce. Although data is limited on the scale of health care worker (HCW) displacement in conflict zones, it is widely acknowledged that conflict conditions result in the displacement of a significant portion of qualified HCWs from their country of origin. While voluntary HCW return is integral to health system rebuilding in conflict-affected and post-conflict settings, there has been little exploration of the nature of national or international policies which encourage HCW return and reintegration to their home countries in the post-conflict period. Methods We conducted a systematic review to identify policies and policy recommendations intended to facilitate the return of displaced HCWs to their home countries and acknowledge their contribution to rebuilding the post-conflict health system. We searched three bibliographic databases and a range of organisational and national health agency websites to identify peer-reviewed articles and grey literature published in English or Arabic between 1 January 1990 to 24 January 2021, and extracted relevant information. We classified policies and policy recommendations using an adapted version of the UNHCR 4Rs Framework. Results We identified nine peer-review articles and four grey literature reports that fit our inclusion criteria, all of which were published in English. These covered issues of repatriation (n = 3), reintegration (n = 2), health system rehabilitation and reconstruction (n = 2); six documents covered several of these themes. Information was available for nine conflict contexts: Afghanistan, Iraq, Kosovo, Lebanon, Namibia, Northern Uganda, South Sudan, Timor Leste, and Zimbabwe. Findings demonstrate that health system rebuilding and rehabilitation serve as precursors and reinforcers of the successful return, repatriation, and reintegration of displaced HCWs. Conclusions Despite the significant numbers of HCWs displaced by conflict, this study identified few specific policies and limited information explicitly focused on the repatriation and reintegration of such workers to their home country in the post-conflict period. Additional research is needed to understand the particular barriers faced by conflict-displaced HCWs in returning to their home country. Conflict-affected and post-conflict states should develop policies and initiatives that address factors within and beyond the health sector to encourage displaced HCW return and provide sustainable reintegration solutions for those who return to post-conflict health systems.
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Affiliation(s)
- Diana Rayes
- The Lancet-AUB Commission of Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Lana Meiqari
- The Lancet-AUB Commission of Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Rouham Yamout
- The Lancet-AUB Commission of Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Iman Nuwayhid
- The Lancet-AUB Commission of Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Samer Jabbour
- The Lancet-AUB Commission of Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Marian Abouzeid
- The Lancet-AUB Commission of Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Alfred Deakin Institute for Citizenship and Globalisation and Centre for Humanitarian Leadership, Deakin University, Geelong, Australia
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Mashange W, Martineau T, Chandiwana P, Chirwa Y, Pepukai VM, Munyati S, Alonso-Garbayo A. Flexibility of deployment: challenges and policy options for retaining health workers during crisis in Zimbabwe. HUMAN RESOURCES FOR HEALTH 2019; 17:39. [PMID: 31151396 PMCID: PMC6544946 DOI: 10.1186/s12960-019-0369-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/30/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Zimbabwe experienced a socio-economic crisis from 1997 to 2008 which heavily impacted all sectors. In this context, human resource managers were confronted with the challenge of health worker shortage in rural areas and, at the same time, had to operate under a highly centralised, government-centred system which defined health worker deployment policies. This study examines the implementation of deployment policies in Zimbabwe before, during and after the crisis in order to analyse how the official policy environment evolved over time, present the actual practices used by managers to cope with the crisis and draw lessons. 'Deployment' here was considered to include all the human resource management functions for getting staff into posts and managing subsequent movements: recruitment, bonding, transfer and secondment. The study contributes to address the existing paucity of evidence on flexibility on implementation of policies in crisis/conflict settings. METHODS This retrospective study investigates deployment policies in government and faith-based organisation health facilities in Zimbabwe before, during and after the crisis. A document review was done to understand the policy environment. In-depth interviews with key informant including policy makers, managers and health workers in selected facilities in three mainly rural districts in the Midlands province were conducted. Data generated was analysed using a framework approach. RESULTS Before the crisis, health workers were allowed to look for jobs on their own, while during the crisis, they were given three choices and after the crisis the preference choice was withdrawn. The government froze recruitment in all sectors during the crisis which severely affected health workers' deployment. In practice, the implementation of the deployment policies was relatively flexible. In some cases, health workers were transferred to retain them, the recruitment freeze was temporarily lifted to fill priority vacancies, the length of the bonding period was reduced including relaxation of withholding certificates, and managers used secondment to relocate workers to priority areas. CONCLUSION Flexibility in the implementation of deployment policies during crises may increase the resilience of the system and contribute to the retention of health workers. This, in turn, may assist in ensuring coverage of health services in hard-to-reach areas.
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Affiliation(s)
- Wilson Mashange
- ReBUILD Consortium and Biomedical Research and Training Institute, 10 Seagrave Road, Corner Seagrave and Sam Nujoma Street, Avondale, P.O. Box. CY 1753, Causeway, Harare, Zimbabwe.
| | - Tim Martineau
- ReBUILD Consortium and Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Pamela Chandiwana
- ReBUILD Consortium and Biomedical Research and Training Institute, 10 Seagrave Road, Corner Seagrave and Sam Nujoma Street, Avondale, P.O. Box. CY 1753, Causeway, Harare, Zimbabwe
| | - Yotamu Chirwa
- ReBUILD Consortium and Biomedical Research and Training Institute, 10 Seagrave Road, Corner Seagrave and Sam Nujoma Street, Avondale, P.O. Box. CY 1753, Causeway, Harare, Zimbabwe
| | - Vongai Mildred Pepukai
- ReBUILD Consortium and Biomedical Research and Training Institute, 10 Seagrave Road, Corner Seagrave and Sam Nujoma Street, Avondale, P.O. Box. CY 1753, Causeway, Harare, Zimbabwe
| | - Shungu Munyati
- ReBUILD Consortium and Biomedical Research and Training Institute, 10 Seagrave Road, Corner Seagrave and Sam Nujoma Street, Avondale, P.O. Box. CY 1753, Causeway, Harare, Zimbabwe
| | - Alvaro Alonso-Garbayo
- ReBUILD Consortium and Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
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