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The resilience of Human Resource Management in context of crisis: cases from northern Uganda and Zimbabwe re build dublin tm

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Presentation on ReBUILD's health worker deployment research given at 4th Global Forum on Human Resources for Health in Dublin 16th November 2017

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The resilience of Human Resource Management in context of crisis: cases from northern Uganda and Zimbabwe re build dublin tm

  1. 1. Research for stronger health systems post conflict The resilience of Human Resource Management in the context of crisis: the case of health worker deployment in Northern Uganda and Zimbabwe Tim Martineau1, Yotamu Chirwa2, Wilson Mashange2, Richard Mangwi3, Alvaro Alonso-Garbayo1 1 Liverpool School of Tropical Medicine, UK; 2BRTI, Zimbabwe; 3Makerere School of Public Health, Uganda Fourth Global Forum on Human Resources for Health, Dublin 13 – 17 November, 2017 @rebuildrpc
  2. 2. Research for stronger health systems post conflict Background • The HRM function of deployment (including recruitment, appointment/ re-appointment, initial posting, transfer and secondment, bonding and promotion ) • Needs of the organisation vs needs of the individual (McGregor 1960) • Resilience needed in HRM systems to cope with shocks (Lengnick-Hall et al 2011) • ReBUILD research: knowledge to inform the development and implementation of pro-poor health systems in countries recovering from political and social conflict/crisis • Study aim: To identify ways to improve the deployment systems of health personnel, during and after conflict or crisis
  3. 3. Research for stronger health systems post conflict Conflict and post-conflict periods in Northern Uganda Source: wikimedia.org Key 1986 - 2006 Conflict 1986 - 2006 Conflict 2006 - 2013 Post conflict 2006 - 2013 Post conflict 1997 Local government act 1997 Local government act • Health centres closed • NGOs provide health care in IDP camps
  4. 4. Research for stronger health systems post conflict The economic crisis in Zimbabwe Zimbabwe GDP 1997 - 2008 Crisis period 1997 - 2008 Crisis period 2009 Dollarisation 2009 Dollarisation 1990 - 1997 Pre-Crisis period 1990 - 1997 Pre-Crisis period 2008 - 2013 Post-Crisis period 2008 - 2013 Post-Crisis period 2007 Retention incentives start 2007 Retention incentives start 2010 Freezing of posts 2010 Freezing of posts 2006 Health Service Regulations 2006 Health Service Regulations Source: tradingeconomics.com – World Bank Health workers leave sector or go abroad
  5. 5. Research for stronger health systems post conflict Methods • Design: mapping deployment policy change and deployment implementation • Document review and key informant interviews (KII) to identify deployment policy and change • KII and in-depth semi-structured interviews (IDI) with managers and 'job histories' with health workers to identify deployment practice, and effects Interviews in Uganda (public sector) Interviews in Zimbabwe (public sector) Type of interview KII (female) IDI manager (female) IDI health worker (female) District Kitgum 5 (2) 3 (0) 6 (2) Gulu 4 (0) 2 (0) 7 (3) Amuru 5 (1) 2 (0) 7 (3) Central 9 (3) 0 0 Totals 23 (6) 8 (0) 20 (8) Type of interview KII (female) IDI manager (female) IDI health worker (female) District 1 0 3 (0) 10 (7) 2 0 2 (1) 15 (9) 3 0 2 (0) 9 (3) Central 17 (7) 0 0 Totals 17(7) 7 (1) 25 (12)
  6. 6. Research for stronger health systems post conflict Findings: deployment policy and practice Intended HR practices Actual HR practices Perceived HR practices Employee reactions Organisational performance Adapted from the HRM-performance causal chain (Boxall and Macky 2007)
  7. 7. Research for stronger health systems post conflict Deployment policy and policy context Uganda • No deployment policy changes due to conflict • Decentralisation of HRM (from 1997) • Support for recruitment nationally Zimbabwe • Few deployment policy changes due to crisis • rapid reappointment process • bonding relaxed due to recruitment freeze • Creation of Health Service Board (2005) • Retention strategy starts (2007)
  8. 8. Research for stronger health systems post conflict Deployment practice - Uganda • Recruitment: Difficult to hire during conflict • Posting: managers refrain from posting to dangerous areas • Bonding for training not enforced during conflict - seen as ‘a way out’ • Posting of couples: In one district, couples were sometimes deliberately not posted together during the conflict • Promotion: No promotion during conflict in one district; used as a reward in another district for those who stayed during the conflict
  9. 9. Research for stronger health systems post conflict Deployment practice - Zimbabwe • Recruitment: preferences, while taken into account before the crisis, were not followed during and after the crisis due to shortage of critical HWs, particularly in rural areas • Reappointment: carried out rapidly - process managed in less than a month • Bonding: managers did not enforce implementation of policy • Transfers: Initial tighter control by managers, then driven by staff due to high number of vacancies and need for managers to retain staffing the sector; finally, after the recruitment freeze, restricted to ‘lateral transfer’ arranged between staff • Secondment: increasingly using secondment option for filling vacant posts, but unpopular due to long periods and process not transparent; lost opportunity for orientation for new staff
  10. 10. Research for stronger health systems post conflict Conclusions • No policy change in Uganda (regional problem); more policy change in Zimbabwe (national problem), though not in the early stages of crisis • More flexibility at the level of practice – attempting to balance the needs of the organisation and the changing needs of the individuals; mostly positive but sometimes negative unintended consequences • Managers in Uganda given greater flexibility with decentralisation; apparent ‘de facto’ decentralisation in Zimbabwe • To ensure greater resilience of HRM policy and practice • More evidence of effective flexibility with policy in conflict/crisis contexts • Managers need better HRM competencies to ensure they are prepared for change and make well-informed choices
  11. 11. Research for stronger health systems post conflict Go raibh maith agat Thank you www.rebuildconsortium.com

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