What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal

Joanna Raven,Sophie Witter,Helen Elsey,Mohamed Samai,Hom Nath Subedi,Tim Martineau,Sally Theobald,Pravin Paudel,Haja Wurie,Sushil Baral

doi:10.1186/s12961-018-0285-1

Abstract

BackgroundHealth workers are critical to the performance of health systems; yet, evidence about their coping strategies and support needs during and post crisis is lacking. There is very limited discussion about how research teams should respond when unexpected crises occur during on-going research. This paper critically presents the approaches and findings of two health systems research projects that explored and evaluated health worker performance and were adapted during crises, and provides lessons learnt on re-orientating research when the unexpected occurs.MethodsHealth systems research was adapted post crisis to assess health workers’ experiences and coping strategies. Qualitative in-depth interviews were conducted with 14 health workers in a heavily affected earthquake district in Nepal and 25 frontline health workers in four districts in Ebola-affected Sierra Leone. All data were transcribed and analysed using the framework approach, which included developing coding frameworks for each study, applying the frameworks, developing charts and describing the themes. A second layer of analysis included analysis across the two contexts, whereas a third layer involved the research teams reflecting on the approaches used to adapt the research during these crises and what was learned as individuals and research teams.ResultsIn Sierra Leone, health workers were heavily stigmatised by the epidemic, leading to a breakdown of trust. Coping strategies included finding renewed purpose in continuing to serve their community, peer and family support (in some cases), and religion. In Nepal, individual determination, a sense of responsibility to the community and professional duty compelled staff to stay or return to their workplace. The research teams had trusting relationships with policy-makers and practitioners, which brought credibility and legitimacy to the change of research direction as well as the relationships to maximise the opportunity for findings to inform practice.ConclusionsIn both contexts, health workers demonstrated considerable resilience in continuing to provide services despite limited support. Embedded researchers and institutions are arguably best placed to navigate emerging ethical and social justice challenges and are strategically positioned to support the co-production of knowledge and ensure research findings have impact.

Highlights

Health workers are critical to the performance of health systems; yet, evidence about their coping strategies and support needs during and post crisis is lacking
Health workers in crisis There is evidence about how health workers respond to epidemics in high-income settings; behaviour is shaped, for example, by fear of contracting disease(s), concern for family health, isolation and information on risks [6–9]
How do health workers cope in times of crisis, and how can they best be enabled to continue their work within different contexts and in response to different crises? Secondly, how should research teams respond when unexpected crises occur during on-going research on the health workforce and health systems strengthening?

Summary

Introduction

Health workers are critical to the performance of health systems; yet, evidence about their coping strategies and support needs during and post crisis is lacking. We live in an uncertain and fragile world where crises, including war, natural disasters and epidemics, with wide reaching repercussions for health systems resilience and health workers’ experiences and the ability to deliver critical services, are arguably increasing. Recent research has highlighted strategies that underpin health workers’ decision to stay serving during the war in northern Uganda [15] and Sierra Leone [16]. Coping strategies in both settings included notions of personal faith, which underpinned a strong sense of personal service to communities in all circumstances, and family support. Given the centrality of health workers to the success of health systems, further research about how to retain, value and support this group during and post crisis is required

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