How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia
Loading...
Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Health Policy and Planning
Abstract
This article is grounded in a research programme which set out to understand how to rebuild
health systems post-conflict. Four countries were studied—Uganda, Sierra Leone, Zimbabwe and
Cambodia—which were at different distances from conflict and crisis, as well as having unique
conflict stories. During the research process, the Ebola epidemic broke out in West Africa.
Zimbabwe has continued to face a profound economic crisis. Within our research on health worker
incentives, we captured insights from 128 life histories and in-depth interviews with a variety of
staff that had remained in service. This article aims to draw together lessons from these contexts
which can provide lessons for enhancing staff and therefore health system resilience in future, especially
in similarly fragile and conflict-affected contexts. We examine the reported effects, both
personal and professional, of the three different types of shock (conflicts, epidemics and prolonged
political-economic crises), and how staff coped. We find that the impact of shocks and coping strategies
are similar between conflict/post-conflict and epidemic contexts—particularly in relation to
physical threats and psychosocial threats—while all three contexts create challenges and staff responses
for working conditions and remuneration. Health staff showed considerable inventiveness
and resilience, and also benefited from external assistance of various kinds, but there are important
gaps which point to ways in which they should be better protected and supported in the future.
Health systems are increasingly fragile and conflict-prone, and shocks are often prolonged or repeated.
Resilience should not be taken for granted or used as an excuse for abandoning frontline
health staff. Strategies should be in place at local, national and international levels to prepare for
predictable crises of various sorts, rather than waiting for them to occur and responding belatedly,
or relying on personal sacrifices by staff to keep services functioning.
Description
Keywords
Health workers, resilience, conflict, economic shocks, Ebola, coping strategies, Sierra Leone, Zimbabwe, Uganda
Citation
Witter, S., Wurie, H., Chandiwana, P., Namakula, J., So, S., Alonso-Garbayo, A., ... & Raven, J. (2017). How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia. Health Policy and Planning, 32(suppl_3), iii3-iii13.doi: 10.1093/heapol/czx112