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Conflict Uganda

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Conflict Uganda Health workers’ career paths, livelihoods and coping strategies in conflict and post- conflict Uganda Justine Namakula, Sophie Witter, Freddie Ssengooba and Sarah Ssali (2013) Acknowledgement This work was supported by UK Department for International Development (DFID) through the ReBUILD Consortium. The authors are deeply grateful for the financial support to carry out this work. This work draws on the life histories and experiences of health workers at different levels of the health system in Gulu, Amuru, Kitgum and Pader. We thank health workers for their patience, time, cooperation, insights and experiences shared during the research process without which this work would not have been possible. We also appreciate the contribution Ms. Adongo Jennifer, Mrs Sarah Auma Ssempebwa, Mr. Deo Tumusange, Mr. Tenywa Ronald, Ms. Resty Nakayima and Ms Eunice Kyomugisha for their hard work and contribution to the data collection and transcription of the interviews. We pray and hope that these research findings make a concrete contribution towards improving subsequent incentive interventions that can make a difference to the lives of health workers in Northern Uganda and other post conflict areas. 2 | P a g e Contents Acknowledgement ..................................................................................................................... 2 Contents ..................................................................................................................................... 3 Executive summary .................................................................................................................... 6 Introduction ........................................................................................................................... 6 Study aim and Methods ......................................................................................................... 6 Findings .................................................................................................................................. 6 Recommendations ..................................................................................................................... 8 Introduction ............................................................................................................................. 10 Research methods ................................................................................................................... 11 Introduction ......................................................................................................................... 11 Study design ......................................................................................................................... 12 Study setting and population ............................................................................................... 12 Tool development ................................................................................................................ 12 Selection of participants ...................................................................................................... 13 Fieldwork .............................................................................................................................. 14 Ethical approval.................................................................................................................... 14 Analysis ................................................................................................................................ 14 Study limitation and strengths............................................................................................. 15 Findings .................................................................................................................................... 15 Description of participants .................................................................................................. 15 Stages in health workers’ careers ............................................................................................ 17 1.Decision to join the medical profession ............................................................................... 17 Personal desire/calling ......................................................................................................... 17 Advice of family and relatives .............................................................................................. 17 Influence of role models ...................................................................................................... 18 Health worker’s dress code ................................................................................................. 19 Respect for health workers .................................................................................................. 20 Health profession as a way of continuing education........................................................... 20 Proximity to health facilities and convents ......................................................................... 21 3 | P a g e Incentives provided to health workers ................................................................................ 21 2. Initial training ....................................................................................................................... 22 Table 3: Training schools attended for initial training ......................................................... 22 Experience of the initial training .......................................................................................... 23 3. Entering employment .......................................................................................................... 24 4. Subsequent postings ............................................................................................................ 25 Subsequent training ............................................................................................................. 27 Sponsorship for subsequent training ................................................................................... 27 Hindrances to further training/upgrading ........................................................................... 28 5. Later stages in careers ......................................................................................................... 29 Conflict as a contextual factor ................................................................................................. 31 Effects of the conflict on health workers’ security and health, and how they coped ............. 31 Abduction ............................................................................................................................. 31 Ambush ................................................................................................................................ 33 Death and fear of death ....................................................................................................... 34 Effects on health workers’ working conditions, and how they coped .................................... 35 Disconnection from professional support ........................................................................... 35 Displacement ....................................................................................................................... 36 Limited supplies/equipment ................................................................................................ 36 Increased workload and long working days ........................................................................ 37 Salary related challenges ..................................................................................................... 40 Localised conflicts ................................................................................................................ 40 Motivators for the health workers ...................................................................................... 41 De-motivating factors for health workers ............................................................................... 43 Health workers’ experiences and perceptions about different incentive policies during and after the conflict ...................................................................................................................... 44 Recruitment and deployment policies ................................................................................. 44 In-service training policies ................................................................................................... 44 Systems of promotion and career progression ................................................................... 44 District splitting and decentralisation .................................................................................. 45 4 | P a g e Primary health care (PHC) grants......................................................................................... 45 Cost sharing/user fees ......................................................................................................... 46 Leave entitlement ................................................................................................................ 47 Provision of non-financial benefits ...................................................................................... 47 Allowances (hard to reach allowance and consolidated allowances) ................................. 48 Policies on dual practice .....................................................................................................
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