Abstract
BackgroundBetween 1986 and 2006, the Acholi region in Uganda experienced armed conflict which disrupted the health system including human resources. Deployment of health workers during and after conflict raises many challenges for managers due to issues of security and staff shortage. We explored how deployment policies and practices were adapted during the conflict and post-conflict periods with the aim of drawing lessons for future responses to similar conflicts.MethodsA cross-sectional study with qualitative techniques for data collection to investigate deployment policy and practice during the conflict and post-conflict period (1986–2013) was used. The study was conducted in Amuru, Gulu and Kitgum districts in Northern Uganda in 2013. Two large health employers from Acholi were selected: the district local government and Lacor hospital, a private provider. Twenty-three key informants’ interviews were conducted at the national and district level, and in-depth interviews with 10 district managers and 25 health workers. This study focused on recruitment, promotions, transfers and bonding to explore deployment policies and practices.ResultsThere was no evidence of change in deployment policy due to conflict, but decentralisation from 1997 had a major effect for the local government employer. Lacor hospital had no formal deployment policy until 2001. Health managers in government and those working for Lacor hospital both implemented deployment policies pragmatically, especially because of the danger to staff in remote facilities. Lacor hospital introduced bonding agreements to recruit and staff their facilities. While managers in both organisations implemented the deployment policies as best as they could, some deployment-related decisions could lead to longer-term problems.ConclusionIt may not be possible or even appropriate to change deployment policy during or after conflict. However, given sufficient autonomy, local managers can adapt deployment policies appropriately to need, but they should also be supported with the necessary human resource management skills to enable them make appropriate decisions for deployment.
Highlights
Between 1986 and 2006, the Acholi region in Uganda experienced armed conflict which disrupted the health system including human resources
Much work has been done on developing incentives to support deployment [3, 4], but the focus here is on a bundle of human resource management (HRM) practices [5] to support equitable deployment of health workers including recruitment and promotion, transfers and bonding
We first present findings on the broader policy environment in the public health sector and Lacor hospital health provider according to the document review and key informant interviews (KII)
Summary
Between 1986 and 2006, the Acholi region in Uganda experienced armed conflict which disrupted the health system including human resources. Much work has been done on developing incentives to support deployment [3, 4], but the focus here is on a bundle of human resource management (HRM) practices [5] to support equitable deployment of health workers including recruitment and promotion, transfers and bonding (see Table 1). Recent literature on posting and transfer covers similar ground [6,7,8,9,10,11] and highlights discrepancies between policy and practice. This literature is based on stable contexts, including India and Ghana, as referenced above. Deployment may face greater challenges, but have a greater role for achieving UHC in conflict and post-conflict situations where staff are scarce and concentrated in urban areas [12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
