Health worker experiences of and movement between public and private not-for-profit sectors-findings from post-conflict Northern Uganda.

Justine Namakula,Sophie Witter,Freddie Ssengooba

doi:10.1186/s12960-016-0114-y

Justine Namakula, Sophie Witter + Show 1 more

Open Access

https://doi.org/10.1186/s12960-016-0114-y

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Abstract

BackgroundNorthern Uganda suffered 20 years of conflict which devastated lives and the health system. Since 2006, there has been investment in reconstruction, which includes efforts to rebuild the health workforce. This article has two objectives: first, to understand health workers’ experiences of working in public and private not-for-profit (PNFP) sectors during and after the conflict in Northern Uganda, and second, to understand the factors that influenced health workers’ movement between public and PNFP sectors during and after the conflict.MethodsA life history approach was used with 26 health staff purposively selected from public and PNFP facilities in four districts of Northern Uganda. Staff with at least 10 years’ experience were selected, which resulted in a sample which was largely female and mid-level. Two thirds were currently employed in the public sector and just over a third in the PNFP sector. A thematic data analysis was guided by the framework analysis approach, analysis framework stages and ATLAS.ti software version 7.0.ResultsAnalysis reveals that most of the current staff were trained in the PNFP sector, which appears to offer higher quality training experiences. During the conflict period, the PNFP sector also functioned more effectively and was relatively better able to support its staff. However, since the end of the conflict, the public sector has been reconstructed and is now viewed as offering a better overall package for staff. Most reported movement has been in that direction, and many in the PNFP sector state intention to move to the public sector. While there is sectoral loyalty on both sides and some bonds created through training, the PNFP sector needs to become more competitive to retain staff so as to continue delivering services to deprived communities in Northern Uganda.ConclusionsThere has been limited previous longitudinal analysis of how health staff perceive different sectors and why they move between them, particularly in conflict-affected contexts. This article adds to our understanding, particularly for mid-level cadres, and highlights the need to ensure balanced health labour market incentives which take into account not only the changing context but also needs at different points in individuals’ life cycles and across all core service delivery sectors.

Highlights

Northern Uganda suffered 20 years of conflict which devastated lives and the health system
At the end of the conflict, the health system was split into a functional camp-based health system run by international agencies and non-governmental organisations (NGOs), on the one hand, and a few government health facilities confined to towns or in protected areas on another [4]
Twenty-six life history interviews were conducted with health workers who were purposively selected, based on district, sector and level of health facility (Table 1)

Summary

Introduction

Northern Uganda suffered 20 years of conflict which devastated lives and the health system. The conflict in Northern Uganda between the Uganda army and the Lord’s Resistance Army (LRA) rebel group lasted for 20 years (1986–2006). This resulted in loss of lives, mass displacement (within and outside the region) for ordinary people and the health workforce, discontinuation of social services and destruction of infrastructure such as roads, schools and health facilities [1,2,3]. The Uganda Catholic Medical Bureau (UCMB), for example, owns 22 % of health facilities in Northern Uganda [7]

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