Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect
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Date
2007
Journal Title
Journal ISSN
Volume Title
Publisher
Human resources for health
Abstract
Despite the expanding literature on how reforms may affect health workers and which reactions they may
provoke, little research has been conducted on the mechanisms of effect through which health sector reforms either
promote or discourage health worker performance. This paper seeks to trace these mechanisms and examines the
contextual framework of reform objectives in Uganda and Bangladesh, and health workers' responses to the changes in
their working environments by taking a 'realistic evaluation' approach.
Methods: The study findings were generated by triangulating both qualitative and quantitative methods of data collection
and analysis among policy technocrats, health managers and groups of health providers. Quantitative surveys were
conducted with over 700 individual health workers in both Bangladesh and Uganda and supplemented with qualitative
data obtained from focus group discussions and key interviews with professional cadres, health managers and key
institutions involved in the design, implementation and evaluation of the reforms of interest.
Results: The reforms in both countries affected the workforce through various mechanisms. In Bangladesh, the effects
of the unification efforts resulted in a power struggle and general mistrust between the two former workforce tracts,
family planning and health. However positive effects of the reforms were felt regarding the changes in payment schemes.
Ugandan findings show how the workforce responded to a strong and rapidly implemented system of decentralisation
where the power of new local authorities was influenced by resource constraints and nepotism in recruitment. On the
other hand, closer ties to local authorities provided the opportunity to gain insight into the operational constraints
originating from higher levels that health staff were dealing with.
Description
Keywords
Health sector, reforms, human resources, Uganda
Citation
Ssengooba, F., Rahman, S. A., Hongoro, C., Rutebemberwa, E., Mustafa, A., Kielmann, T., & McPake, B. (2007). Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect. Human resources for health, 5(1), 1-13.10.1186/1478-4491-5-3