Research for stronger health systems during and after crisis

Health Workers


Human resources for health is the most expensive, complex and critical health system pillar, and one with more political ramifications – it is crucial to learn lessons about how to rebuild the health workforce effectively post-conflict.

Health worker attraction, retention, distribution and performance are particularly important factors affecting the performance of a health system. In post-conflict settings, where health systems and health worker livelihoods have been disrupted, the challenges facing the establishment of the right posting and incentive environment are particularly important, and the contextual dynamics around them especially important to understand and incorporate sensitively into policy measures. REBUILD therefore chose this topic as one of its focus areas for the first stage of research.

A cross-cutting analysis of ReBUILD’s wide-ranging series of studies since 2011, on health worker incentives and on deployment policies, has produced a number of important findings and recommendations, and have informed some key themes around human resources for health in post-conflict settings.

These sub-themes are:

Attraction and retention

Conflict forces staff to flee or adapt, although staff can show great resilience in coping with crisis.

Local staff and mid-level cadres, commonly female, have shown more willingness to stay in remote areas in some settings.

ReBUILD’s work shows what is needed to support staff to stay and work in underserved areas after conflict – this includes more recognition of their role and achievements in challenging circumstances, practical measures to improve their security and provision of decent housing, working conditions and pay.

Rebuilding trust, communication and teamwork is also key.

Gender and the health workforce

ReBUILD’s research showed how health worker’s strategies and experiences during and after conflict are shaped by gender, poverty and household structure.

Whilst women predominate in the workforce, they are under-represented in management positions and clustered in lower paying positions. Most HRH regulatory frameworks did not sufficiently address gender concerns. Gender roles also affect attitudes to rural deployment and women in all contexts face particular challenges in accessing training.

ReBUILD’s work on gender and health systems in conflict and fragility has been developed into a specific on-line resource – Building Back Better.


Flexibility in the implementation of deployment policies during crises, particularly to rural areas, may contribute to increased retention which in turn may assist in ensuring coverage of health services in hard to reach areas.

Taking into account workers’ preferences in terms of work location is always important but even more so during crises.

Rigidity in deployment can lead to attrition which in turn can affect service delivery.





Life Stories