How to promote a resilient
heath workforce in conflict
affected areas: insights
from four countries
Chair: Sophie Witter
HSG, 18 November 2016
Research for stronger health systems
post conflict

Overview
• Background on ReBUILD & health worker incentive
research
• Health workers’ motivation to join the profession
(Justine Namakula)
• Health workers’ experience of crisis and conflict & how
they coped (Haja Wurie)
• Health worker’s experiences of incentives and incentive
policies post conflict and crisis (Sophie Witter &
Yotamu Chirwa)
• How health staff manage complex remuneration in
fragile and post-conflict settings (Maria Bertone)
• Wrap up and overview of resources
• Discussion
Research for stronger health systems
post conflict

Background on ReBUILD
Decisions made early post-conflict can steer the long
term development of the health system
Research for stronger health systems
post conflict
Post conflict is
a neglected
area of health
system
research
Opportunity
to set health
systems in a
pro-poor
direction
Useful to think
about what
policy space
there is in the
immediate post-
conflict period
Choice of focal
countries
enable distance
and close up
view of post
conflict

ReBUILD research and partnerships
Health
financing
Gender &
equity
Health
workforce
Aid
effectiveness
Contracting
models
Health systems
and resilience
Research for stronger health systems
post conflict
Consortium partners
• College of Medicine and Allied
Health Sciences (CoMAHS),
Sierra Leone
• Biomedical Training and
Research Institute (BRTI),
Zimbabwe
• Makerere University School of
Public Health (MaKSPH),
Uganda
• Cambodia Development
Research Institute (CDRI)
• Institute for International Health
and Development (IIHD), Queen
Margaret University, UK
• Liverpool School of Tropical
Medicine (UK)
Consortium affiliates working in
additional countries: Cote d'Ivoire,
Nigeria and South Africa; Sri
Lanka, Gaza and Liberia

Background on ReBUILD research on
health worker incentives
Research tools Cambodia Sierra Leone Uganda Zimbabwe
1. Stakeholder mapping √ √
2. Document review √ √ √ √
3. Key informant interviews √ 33 √ 23 + 18 + 19 √ 25 √ 28
4. Life histories with HWs √ 24 √ 23 + 39 +25 √ 26 √ 34
5. Quantitative analysis of
routine HR data
√ √ √
6. Survey of health workers √ 310+266
(+logbooks)
√ 227
Witter, S., Chirwa, Y., Namakula, J., Samai, M., Sok, S. (2012) Understanding
health worker incentives in post-conflict settings: study protocol. ReBuild
consortium. http://www.rebuildconsortium.com/media/1209/rebuild-research-protocol-
summary-health-worker-incentives.pdf
Research for stronger health
systems post conflict
Objective: to understand the evolution of incentives for health workers
post-conflict and their effects on HRH and the health sector

Scope and sample sites
Cambodia Sierra Leone Uganda Zimbabwe
Site
selection
6 provinces (covering
all 4 ecological
regions)
4 districts
(covering all
main regions)
3 districts in most
conflict-affected area
2 provinces – one
well served and one
under-served
Sectors
included
Public sector only Public sector
only
65% public; 35%
PNFP (private not-
for-profit - largely
mission sector)
Mixture ranging from
the government
sector; the
municipality; the
Rural District
Councils, the mission
sector and the private
sector
Time-
frame
1999 onwards (post-
conflict)
2000 onwards
(last phase of
conflict; post-
conflict since
2002)
2000 onwards (six
years during; six
years after)
1997 onward
(economic crisis, and
post- since 2009)

Motivation to join
health workforce:
learning from four
settings
Justine Namakula
Research for stronger health systems
post conflict

Focus
• Factors influencing motivation to join
• Patterns in expressed motivation to join the
profession across different settings and cadres
• Linkage between motivation and retention
• Implications for HRH policies in the health
systems studied

Factors influencing
motivation to join
Personal calling
• Desire to serve communities
• Innate caring personality
“Reason for choosing this career because I
love it and can help people in my
community” (Cambodia)
“…. it was a calling and feeling of wanting to serve people,
so I thought that if I am trained I can also come and save
the life of my people” (Uganda)

Family influence
• Instruction and advice
• Role models
• Relatives with health problems
“I became a nurse because […] I was also
encouraged by my grandfather who was
employed at Mashoko Mission Hospital to join
the nursing field “ (Zimbabwe)
‘[…] My Mother too wanted me to do nursing
[…]She made all the arrangements that I should do
nursing because she had wanted to do it but she
did not do it.. […]that’s what made me to do it[…]
(Sierra Leone)
Factors influencing
motivation to join

Factors influencing
motivation to join
Status and esteem of health professionals
“I learnt that doctor had good income and respect from people in the
community. I can also help people” (Cambodia)
‘From the way I saw how the nurses were all well-dressed at that time,
the doctors were working efficiently…….. ‘(Sierra Leone)
‘’[...] I could see the nurses fully dressed and very smart. So that is one
thing that inspired me mostly. I therefore decided that I should be a
nurse and be smart like them’’ (Uganda)
‘ I used to adore nurses in their white uniforms since I was young so I
came to train as a nurse in 1995 up to May 1999” (Zimbabwe)

Factors influencing
motivation to join
Economic factors
• Perceived better pay than other professions
• Incentives (Uganda)
• Means of survival for family (all)
• Short training time= money more quickly (Cam)
• Scholarships for medical training (SL)
Educational background
• Science subjects
• Flexibility in level of education background
• Failure to get medicine [some cadres]
Proximity to facilities
• For those who joined through volunteering

Policy implications for
resilience
Recruitment strategies for retention in hard to serve areas should focus on
staff with strong intrinsic motivation
• key for conflict and crisis (erratic pay, difficult working conditions, non-functional formal
promotion structures) [e.g. Ug.]
Training policies should focus on offering good access for less advantaged
local students
• May contribute to strong retention and loyalty to sector
Volunteering
• should not be ‘abused’ [ e.g. SL].
• also need to ensure quality
Consider themes of professional status in policy circles
• Uniforms ( SL, Zim, Ug]
• Maintain respect [ Ug]
• Revive trust in epidemiological crisis [ SL]
• Maintain brand image?[ may be costly but also very beneficial]

Effect of conflict &
crisis on health
workers and coping
mechanisms
Dr Haja Wurie
Research for stronger health systems
post conflict

Conflict – Northern Uganda, Cambodia,
Sierra Leone
• Cambodia
• 1969-1978 conflict - Khmer Rouge regime
• Devastating effects on social and economic infrastructures and severe HRH
implications
• 1979: Regime partially overthrown in 1979, but continued conflict in some areas
• 1999: reconstruction initiated but challenges for the health system still exist
• Northern Uganda
• Conflict lasted 20 years (1986-2006)
• Negative impact for the broader health system including health workers who stayed
• Peace Recovery and Development Plan
informed the post conflict recovery phase to
improve the general health service delivery
• Sierra Leone
• Civil war that spanned 11 years ending in
2002 Health care system devastated and
its effect still evident a decade after the war

Economic crisis - Zimbabwe
• Resulted in the decline of
Zimbabwe’s Gross Domestic
Product leading to
inadequacies to finance
government services.
• Negative impact on the
economy between 2000 and
2008
• Mid-2008, hyper-inflation led
to the demonetisation of the
Zimbabwe dollar and the
adoption of multiple currencies
as official tender in 2009
• Decline in living standards and
increase in poverty occurred
during this crisis period,
alongside dramatic decline in
health indicators
Decade long socio-economic and political crisis between 1997
and 2009

Ebola – Sierra Leone (2014-15)
• All efforts made in the post
conflict phase suffered a major
setback
• Outbreak and the response
further exposed the gaps in the
health sector
• Second rebuilding phase
underway

Effect of conflict on health workers
Personal
• Abduction
‘…. I was abducted by rebels in 1993. I was
with the rebels up to 1995, and when I gained
my freedom..’ (Sierra Leone)
‘…and so the rebels went with the clinical
officer to go and tell them which drug works
for which infection[...] but he came back after
some months…’ (Northern Uganda)
• Death and injury
‘My family had 6 members, after Khmer
Rouge, only 3 were left. My father was taken
for education and never returned. My sister
and brother died of malaria’ (Cambodia)
• Insecurity and fear
“…soldiers coming to hospital for service and
when we could not provide them service or
medicine as fast as what they wanted,
sometime they shot to the air or they
threatened us” (Cambodia)
“Then you could hear gunshots, someone
shooting just very near at times you feel like
you are going to be short at that time, that
fear was there” (Northern Uganda)
Professional
• Overload
“Also in the PHU the work load was too much,
the staff capacity was very low […] initially we
were only 3, myself, the CHO, one SECHN and
one MCH aide, so we were subjected to work
right round the clock… (Sierra Leone)
• Challenging working conditions
“At the beginning it was terrible. The hospital
at Prek Pnov had only one or two beds and
there were a lot of patients who got malaria,
diarrhoea, and so on. The road was often very
bad. It was not really safe, some of the
sounding area, Khmer Rouge pass by very
often” (Cambodia)
• Non-receipt of salary
‘…we lived by magic […] you don’t know when
you will get your salary and what you have at
home you don’t want it to get finished because
there are children […] So we had to manage
the finances […] the little we had […] People
who had the stuff will hide it because they
don’t want it to get finished and what you
wanted you are searching all over the place.
Even one of our church members lost his life
just going out to look for rice and he was shot’
(Sierra Leone)

Effect of economic crisis on health workers
• Increased shortages of staff
“…there are challenges of shortage of human resources and other materials. We are short
staffed; six nurses short, there is need to increase the number of nurses” (Zimbabwe)
• Devaluation of pay
• Resource shortages at work
“There is a shortage of drugs and there are no doctors, it is very difficult to work in those
conditions. There is also a shortage of equipment and drugs to use during labour, people endure
pain for a long time and at times there will be no driver for the ambulance to transfer the
patients to a referral hospital” (Zimbabwe)
• Living conditions
“Staff accommodation is also a problem - some nurses are staying in boys hostels and there are
no cooking facilities and some building have deteriorated but they cannot be renovated because
of lack of funds” (Zimbabwe)
• Loss of quality and discipline
“There is no transparency in the recruitment of students and workers. You will see a husband,
wife and children working at the same place. You cannot control behaviour of people with
power, they corrupt the situation and they are difficult to manage and supervise” (Zimbabwe)

Effect of Ebola on health workers
Personal
• Fear of death
• Fear of patients
• Changed family dynamics
“I left home and since then I’ve not been
back because I didn’t want to work with
patients and go home and if I should fall
sick, if its Ebola then my family will have to
be in quarantine for 21 days […] this is one
sacrifice I have had to make to get
separated from my family”
• Community stigma
“(They were) saying your husband is
working there, please don’t get from our
(water) well […]So my wife is really stressed
by them. I always told her ‘please just be
calm, we know we are doing the right thing,
let us pray”
Professional
• Lack of supplies and
equipment
“You need to have the necessary
equipment to fight. What has been the
problem is that even when there is this
readiness of facing this battle we have not
been given the proper equipment to fight.”
• Increased stress and workload
• Economic difficulties
“Many health workers, their basic earning
power decreased as a result of Ebola. So it
has this economic impact….”
• Worsened relationships with
colleagues
“… colleagues in the general ward they
were really intimidating us. If I walked
through this corridor, they will just move
and just give a space for me to pass.”

Similarities and differences
Physical
safety
(conflict and
epidemics)
Psycho-social
(conflict and
epidemics)
Working conditions
and remuneration
(all shocks)
Impact of
shock on
health
workers
• Death and
injury
• Infection
• Fear for self,
family and
colleagues
• Loss of trust in
community, in
colleagues, in
patients
• Disrupted family
lives
• Stress
• Overload
• Lack of resources for
working and living
• Blockages or loss of
pay and
remuneration
• Loss of quality and
discipline in the
workplace

Coping strategies
Physical
safety
(conflict and
epidemics)
Psycho-social
(conflict and epidemics)
Working conditions and
remuneration
(all shocks)
Coping
by
health
workers
• Self-
protection
• Internal values and
resources, including
religion, patriotism etc.
• Personal strategies for
distraction, comfort and
sedation
• Peer support, including
through social media
• Family support
• Additional earning options
• Dual practice (mainly in
economic crisis)
• Borrowing money
• Working longer hours
• Task shifting and taking on
new roles; improvisation to
cover material shortages
• Informal movements of staff
• Using own resources for
patients or passing on costs to
patients
External
support
• Protective
materials
provided
• Managerial support (local
and international)
• Workshops and training
• Rebuilding relationships
with communities
• Donor support
• Expatriate staff support
• Additional allowances (e.g. risk
allowance)

Policy implications
Working
conditions and
remuneration
• Plans in place for rapid response – e.g. providing
back-up drug supplies
• More flexible payment systems for staff
• Greater freedom for local responses
• Redeployment where needed
Physical safety • Enforcement of protective laws for health workers
during conflict
Psycho-social • More proactive communication
• Support for health staff and communities in all
crises

HRH incentive policies
post-conflict and crisis
Sophie Witter & Yotamu Chirwa
Research for stronger health systems
post conflict

Analysing policy evolution across
contexts
• HRH challenges widely shared across the four cases in the post-conflict period but that the
policy trajectories were different – driven by the nature of the conflicts but also the wider
context
• Problems are well understood in all four cases but core issues – such as adequate pay,
effective distribution and HRH management – are to a greater or lesser degree unresolved
• These problems are not confined to post-conflict settings, but underlying challenges to
addressing them – including fiscal space, political consensus, willingness to pursue public
objectives over private, and personal and institutional capacity to manage technical solutions –
are liable to be even more acute in these settings.
• The role of the MoH emerged as weaker than expected, while the shift from donor
dependence was clearly not linear and can take a considerable time
• Financial and technical dependence can change at different paces
• Windows of opportunity for change and reform can occur but are by no means guaranteed
by a crisis – rather they depend on a constellation of leadership, financing, and capacity
• Recognition of urgency is certainly a facilitator but not sufficient alone
• Evidence of path dependency in decisions made post-conflict
• Post-conflict environments face particularly severe challenges to evidence-based policy
making and policy implementation, which also constrain their ability to effectively use the
windows which are presented

Incentive packages
Incentives – need to ensure a balanced package over time, once the intensity
of the conflict experience recedes, which prioritises those who serve in hard-
to-reach areas but also ensures equity across conflict lines.
• Consultation of staff is key in developing these policies; good communication within
facilities and within the sector is a ‘low hanging fruit’
• Also reinforcing supervision and improving working conditions
• Aspects which require more organisational change can receive less priority than
financial incentives, which donors find easier to finance
In PC settings, similar motivations for staff and changing aspiration over the
career cycle to more stable settings but even greater tendency to
fragmentation of incentive structures
• Linked to multiple actors?
• Incentive policies tend to be piecemeal, poorly funded and implemented
• No feedback loops
• Policies often crafted with external inputs but limited traction
• Some areas of reform particularly hard to address, like management reforms
• Some countries experience increased patronage/interference with postings and
promotions
Phases: fragmentation initially may be adaptive, but when to harmonise (e.g.
Timor Leste – on to payroll quite quickly).
Also opportunities to learn and innovate - e.g post-Ebola SL; able now to
capitalise on interest; use evidence from past.

Mind the (sectoral) gap
The conflict/post-conflict dynamics can affect the balance
of attraction and retention across sub-sectors within health,
distorting the provision of care.
• e.g. in northern Uganda, during the conflict, the PNFP sector remained more
functional, including in terms of supporting staff with pay.
• The public sector was boosted in the post conflict phase due to increased
investments under the PRDP, consolidation of allowances and introduction of
hard to reach allowances. The salaries also became more regular while
pension continued to be provided.
• Our findings suggest that retention within the PNFP sector has had to rely on
more personal factors, such as loyalty and family ties, while many still
working in the PNFP sector express the intention to leave, if circumstances
permit.
• In Zimbabwe, the public sector has been unable to offer the same terms and
conditions for staff, given the crisis; the municipalities have independent
income source and so employ more senior staff to do less demanding roles in
urban clinics, adding to shortages in other areas

Rural retention
Rural health workers face particular challenges, some of which stem from the
difficult terrain, which add to common disadvantages of rural living (poor
social amenities etc.).
• Poor working conditions, emotional and financial costs of separation from
families, limited access to training, longer working hours (due to staff
shortages) and the inability to earn from other sources make working in rural
areas less attractive.
• Moreover, rules on rotation which should protect staff from being left too long
in rural areas are not reported to be respected.
• Incentives for rural areas limited political focus – especially ineffectual?
• Insecurity
By contrast, poor management had more resonance in urban areas, with
reports of poor delegation, favouritism, and a lack of autonomy for staff.
Tensions within the team over unclear roles and absenteeism are also
significant demotivating factors in general.
Local staff & mid-level cadres more likely to work in remote areas
During economic crisis, rural areas can have advantages (e.g. Zim – lower
costs, able to subsist etc.)
To work in remote areas workers need:
• recognition of role and achievements in challenging circumstances
• practical measures to improve their security
• provision of decent housing, working conditions, training and pay
• trust, communication and teamwork

The gendered health workforce
• Lack of balance: in all contexts women predominate in
nursing and midwifery cadres; are under-represented in
management positions and tend to be more clustered in
lower paying positions
• Gender roles, shaped by caring responsibilities at the
household level, also affect attitudes to rural deployment and
women in all contexts faced particular challenges in accessing
both pre- and in-service training as compared to their male
counterparts
• Conflict and coping strategies within conflict emerged as a
key theme, with gendered strategies and experiences also
shaped by poverty and household structure
• Most HRH regulatory frameworks did not use the PC moment
to address gender. Key priority areas for addressing gender
equity in the health workforce in FCAS include (1) ensuring
gender is integrated into policy and (2) fostering dialogue and
action to support change for gender equity within institutions
and households.
Research for stronger health
systems post conflict

Overview of incentive evolution in
Zimbabwe
• Inability to remunerate health staff effectively since start of crisis
• Emergency response from international partners, who contributed to the
retention allowances and later critical post allowances, was crucial after the
crisis in 2009
• Contributed to a reduction of internal movement of health workers as a
result of an improvement in incentives in the post- crisis period (harmonized
retention, HTF and RBF)
• Dollarisation in the immediate emergence from crisis also contributed to the
relative stabilisation of the health workforce
• RAA is the only incentive specific to rural areas, but has not been effective
because it is universal, low and not related to hardship posts
• Senior and experienced health personnel concentrated in PHC facilities (in
municipalities)
• Insecurity of allowances and debates over who receives them continue… with
renewed threat of brain-drain

Salary differentials
• Higher salaries in the municipality compared to public and mission
subsector (main providers of health care in rural areas)
• Nurses and midwives willing to take up positions in the municipal
subsector even if they were more senior and qualified because of
the higher salaries
32
Cadre Government Municipality Mission
Cadre Maximum
salary (USD)
Maximum salary
(USD)
Maximum
salary (USD)
EHP 420 2,700 550
MWs 485 2,200 350
Nurses 434 2,203 400

Comparison of hourly rates of
remuneration by sector (2013)

Other benefits, by sector
0%
10%
20%
30%
40%
50%
60%
Govt
Municipality
Mission
Govt
Municipality
Mission
Govt
Municipality
Mission
Housing Food Health
Care
Percentange of cadres
who received non-
financial benefits by sub-
sector
0
20
40
60
80
100
120
140
160
180
Amountin$
Incentives paid by sub-sector in
$
Government
Municipal
Mission

Health workers experiences of
different sectors in Zimbabwe
Municipal health workers
after qualifying I worked at
[FBO]at City Health since 1988… I
applied …was …interviewed and I
passed the interview. …I’m staying
here till retirement… I’m getting a
very good salary, housing
allowance, professional
allowance, midwifery allowance,
water allowance, transport
allowance (IDI 015 female
Nurse
I applied to the municipality for a
job, was interviewed and got the
job in 1990 and ever since I have
been a nurse in the municipality
and I will retire from here in a
year’s time (IDI 003Nurse
‘
Public sector
I am not happy, am not satisfied
because of the salary and the
conditions of service. A person in
my post must have incentives e.g.
car loan, i.e. incentives that make
you comfortable (IDI 011 female
matron Public sector District 1)
Salaries in the public sector were
unrealistically low especially during
the difficult times…there is some
improvement, health workers
continue with private work and the
question of whether this is
sanctioned or not does not arise
because the salaries are very low.
(KII 22 female Doctor Public
sector)

‘I am managing’: complex
remuneration and income use
strategies of primary health
workers in Sierra Leone
Maria Bertone
Research for stronger health systems
post conflict
www.fondation-aedes.org
F
O
N
D
A
T
I
O
N

Background
• Limited evidence on health workers’ actual earnings in post-
conflict settings
• Formal allowances, but also informal incomes
• Is the incentive package is effective in addressing HRH
challenges?
• How much do primary health workers earn?
• What are health workers’ perspectives and views on their
incomes?
• How do health workers use their incomes?

Methods

Methods (1)
• Survey of 266 primary health workers in 198 randomly selected
health centres in Bo, Kenema and Moyamba
• Different cadres of nurses and nursing aides
(CHOs, CHAs & nurses MCH Aides)
• Daily logbook completed by health
workers over 8 weeks detailing
incomes earned and activities
performed
• 39 in-depth interview with a
sub-sample of health workers

Methods (2)
Cross-sectional
survey
Share of user fees
Salary
Remote Allowance
PBF (individual bonus)
Salary supplementations / top-ups
Per diems
Non-health income-generating
activities
Longitudinal
logbook
Gifts and payments from patients
Sale of drugs and items w/in facility
Private practice

Implementation of HRH reforms
“They [MoHS at central level] don’t even communicate with us. We are dealing with the staff
here, we know the staff movement. [...] But they say that they have the data there. But
sometimes they pay staff that are not even in remote areas” (KII – DHMT)
“I mean, [PBF] is good in theory, but when it comes nine months
later, I think it defeats the whole purpose” (KII – DHTM).
“I heard many, many health workers, PHU staff, and DMOs talk about performance-based
financing. I've never heard anyone mention this remote area allowance”(KII – NGO).
“The real key issue is that with all of these policies and all of these strategies, none of them have been properly
operationalised and none of them have stayed around. Like, in 2002, there was a free health care policy
announced [...] and then it just didn’t happen. So free health care is announced again in 2010, and it’s like,
OK, it’s happening, but is that going to slowly start to fall apart? If PBF is announced, it’s like, oh it comes and
then it stops, you know.” (KII – NGO).
Remote allowance: 5%-8% of income of all HWs (Dec. 2012)  delayed and then stopped from Jan. 2013
Performance Based Financing: 11% of income of HWs (Sept. 2013)  payments received more than one
year later than services are performed
Health workers’ incomes

Health workers’ incomes

Health workers’ views of their incomes

Health workers’ views of incomes (1)
• Somewhat incongruous accounts on incomes
• Importance of non-financial features of incomes:
• Entitlement vs. windfall
• Ease of access (cash vs. bank)
• Fairness and transparency
• Delays in payment
• Transparency in sharing practices
• Income fragmentation as an issue
PBF “helps”, “good money”, “really
enough” (HWs in all districts).
Salary is “not enough”, “is small
for the job”, is “not satisfying”
(HWs in all districts).

Health workers’ views of incomes (2)
• Health workers said that they “manage”
“Well, if I gather everything
together at the same time it
helps [i.e. my income is
enough], but the money does
not come together, it comes in
little bits. So what I have at the
moment, I manage with it. I
have no other way to do it”
(CHA/nurse in Kenema).
“I have to manage my
life with it [my
income]” (MCH Aide
in Moyamba)
“Well, it is not easy.
You have to manage
yourself” (CHA/nurse
in Moyamba)

Health workers’ use of incomes
• Health workers take advantage of the different financial and non-
financial features of their incomes  spend different incomes
differently
• Salary
• High and regular (“earmarked”) expenditures
• Received through bank account and not readily available
• Subject to family pressures
• Per diems, non-health activities, in-kind gifts from patients and
communities
• Personal subsistence while in post+ emergency expenditures
• Readily available
• Unknown to family (“hidden”)
• PBF bonus
• Substantial amount which can be re-invested in non-health activities (e.g. business
such as buying palm oil, etc.)

Background
Policy implications

Policy implications (1)
• How generalizable are these findings to other settings?
• Formal revenues are the most important income for health workers
and essential for their motivation
 improve management of official payments
• Salary payroll
• Remote allowance to improve retention/motivation in rural areas
• PBF bonuses
• Strengthen routine information system
• Decentralize HRH management
• Streamline and clarify allowances
• Improve transparency and regularity of payments

Policy implications (2)
• Non-governmental incomes are also key in the income utilization
strategies of health workers
Improve incentive packages for health workers
• Gather information on the entire remuneration of health workers,
including informal incomes, and include them in harmonization efforts
(e.g. per diems)
• Reflect on the health workers’ perspectives and use of their incomes
• Incomes are not fully ‘fungible’
 Think of post-conflict/crisis legacies
• Income fragmentation due to presence of NGOs (per diems and salary
supplementations)? Where? For how long?

Thanks to the whole team and all
research participants
Cambodia: Sovannarith So, Sothea Sok
Sierra Leone: Haja Wurie, Mohamed Samai
Uganda: Justine Namakula, Freddie Ssengooba
UK: Sophie Witter, Maria Bertone, Alvaro Alonso-
Garbayo
Zimbabwe: Yotamu Chirwa, Pamela Chandiwana,
Wilson Mashange, Mildred Pepukai, Shungu
Munyati

Thank you
All resources can be found
on the ReBUILD website:
www.rebuildconsortium.com
Contact:
switter@qmu.ac.uk
@ReBUILDRPC
https://rebuildconsortium.com/media/1410/hrh-
resources-from-rebuild-october-2016.pdf