Health workers’ career paths, livelihoods and coping strategies in conflict and post-conflict Uganda

Abstract

This study aimed to understand the livelihoods of health workers along with their coping strategies for dealing with conflict. It also examined public incentive policies both during and after the conflict in northern Uganda. Using a life history approach, 26 case studies were conducted with serving health workers in four districts of the Acholi sub-region in northern Uganda; Gulu, Kitgum, Amuru and Pader. The report highlights conflict as a major contextual factor which affected both the lives and career choices of health workers. Participants recalled traumatic situations and innovative coping strategies during conflict, as well as stressing the commitment and resilience of some health workers throughout this period. Strategies for coping with the conflict included task shifting, disguising themselves, hiding amongst the community and finding innovative ways to work with limited supplies. They also deployed psychological strategies such as fatalism and relying on their faith. In general, the findings suggest the importance of selecting and favouring health workers with a higher level of intrinsic motivation. In difficult times, when working conditions are tough, salary is erratic and formal structures of promotion and recognition cannot function well, motivation is key. Strong leadership, supportive professional relationships, good links to the community and small in-kind rewards appear to have incentivised these staff to stay in turbulent times. The study highlighted the existence of a crowded policy environment within which health workers operate. Efforts are needed to evaluate such policies from the perspective of the health workers. This research is supported by the Department for International Development’s ReBUILD Programme which is led by Liverpool School of Tropical Medicine