Abstract
Introduction: Life history is a research tool which has been used primarily in sociology and anthropology to document experiences of marginalized individuals and communities. It has been less explored in relation to health system research. In this paper, we examine our experience of using life histories to explore health system trajectories coming out of conflict through the eyes of health workers. Methods: Life histories were used in four inter-related projects looking at health worker incentives, the impact of Ebola on health workers, deployment policies, and gender and leadership in the health sector. In total 244 health workers of various cadres were interviewed in Uganda, Sierra Leone, Zimbabwe and Cambodia. The life histories were one element within mixed methods research. Results: We examine the challenges faced and how these were managed. They arose in relation to gaining access, data gathering, and analysing and presenting findings from life histories. Access challenges included lack of familiarity with the method, reluctance to expose very personal information and sentiments, lack of trust in confidentiality, particularly given the traumatized contexts, and, in some cases, cynicism about research and its potential to improve working lives. In relation to data gathering, there was variable willingness to draw lifelines, and some reluctance to broach sensitive topics, particularly in contexts where policy-related issues and legitimacy are commonly still contested. Presentation of lifeline data without compromising confidentiality is also an ethical challenge. Conclusion: We discuss how these challenges were (to a large extent) surmounted and conclude that life histories with health staff can be a very powerful tool, particularly in contexts where routine data sources are absent or weak, and where health workers constitute a marginalized community (as is often the case for mid-level cadres, those serving in remote areas, and staff who have lived through conflict and crisis).
Highlights
Life history is a research tool which has been used primarily in sociology and anthropology to document experiences of marginalized individuals and communities
The life histories build on one of the most essential human characteristics – telling stories and making sense of the world through our own life experiences. They have shown their potential to contribute to health system research
A life history is a case study based on the story of an individual, they focus on individuality, subjectivity and the particular experience (Plummer, 1983)
Summary
Life history is a qualitative method used often in sociology and anthropology. A life history is a case study based on the story of an individual, they focus on individuality, subjectivity and the particular experience (Plummer, 1983). The narrative of the interaction of the health workers with the social environment in which they lived and worked through their professional life allowed us to understand how they experienced the process of post-conflict reconstruction. Through their lives and experiences we sought to obtain an understanding of the evolution of the health system and the different processes related to the work environment. This paper presents some of the challenges and lessons learned in the process of using the life history approach with health staff in Sierra Leone, Zimbabwe, northern Uganda and Cambodia
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