Category: Peer-reviewed papers

The political economy of results-based financing: the experience of the health system in Zimbabwe

ReBUILD paper examining political economy factors behind adoption of results-based financing and shifts in influence & resources it may bring


Leaving no one behind: the role of gender analysis in strengthening health systems

A special supplement of Health Policy and Planning which draws together papers which examine gender across a range of health policy and systems contexts. Includes ReBUILD work.


How should community health workers in fragile contexts be supported: qualitative evidence from Sierra Leone, Liberia and Democratic Republic of Congo

Paper presents evidence from three fragile settings – Sierra Leone, Liberia and Democratic Republic of Congo – on managing community health workers and recommends best approaches to support them


Employment based health financing does not support gender equity in universal health coverage

This paper argues that health financing and entitlement systems linked to employment can actually disadvantage women and explores how that happens


Performance-Based Financing, Basic Packages of Health Services and User-Fee Exemption Mechanisms: An Analysis of Health-Financing Policy Integration in Three Fragile and Conflict-Affected Settings

Research looking at whether and how performance-based financing is integrated with national financing strategies, especially in fragile and conflict-affected settings


Results-based financing as a strategic purchasing intervention: some progress but much further to go in Zimbabwe?

Research which empirically and systematically examines how results-based financing impacts on health care purchasing in Zimbabwe


The Impact of Leaving Camps on Well‐being of Internally Displaced Persons in Northern Uganda

Paper that explores the estimated changes in internally displaced persons’ well‐being having left transit camps in 2006 following armed conflict in Northern Uganda.


Socio-cultural change in conflict and post conflict settings: five decades of giving birth in Cambodia

Research explores the changing experience of giving birth in Cambodia over 53 years of conflict, privation, invasion & civil unrest


Health system strengthening – reflections on its meaning, assessment and our state of knowledge

Paper reflecting on undertaking a health systems strengthening review, drawing out suggestions on definitions and approaches to assessment, plus key conclusions


Flexibility of deployment: challenges and policy options for retaining health workers during crisis in Zimbabwe

ReBUILD study looking at the implementation of health worker deployment policies in Zimbabwe before, during and after the 1997-2008 crisis


Health financing in fragile and conflict-affected settings: What do we know, seven years on?

Paper from ReBUILD looking at literature on health systems financing in fragile and conflict-affected settings and how it has changed in 2012-19


“Posting policies don’t change because there is peace or war”

Paper looking at how deployment policies & practices were adapted during and after conflict in Acholi, Uganda


(How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo

Results-Based Financing has proliferated in health sectors of low and middle income countries, especially fragile and conflict-affected ones, and has been presented as a way of reforming and strengthening strategic purchasing. However, few studies have empirically examined how RBF impacts on health care purchasing in these settings. This article examines the effects of several RBF programmes on health care purchasing functions
the past decade.


Resources from ReBUILD’s research on gender in post-conflict health systems

Details of all outputs from ReBUILD’s work on gender and post-conflict health systems.


Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach

ReBUILD research paper focusing on the importance of psychosocial support services for adolescent girls in fragile contexts


Understanding HRH recruitment in post-conflict settings: an analysis of central-level policies and processes in Timor-Leste (1999–2018)

The study explores how the human resources for health recruitment policies changed in Timor-Leste from 1999-2018, the drivers of change and their contribution to rebuilding an appropriate health workforce after conflict.


The bumpy trajectory of performance-based financing for healthcare in Sierra Leone

A ReBUILD paper on the development of performance-based financing for healthcare in Sierra Leone


Are health systems interventions gender blind? Examining health system reconstruction in conflict affected states

ThisReBUILD paper examines if and how rebuilding health systems affected gender equity in four post-conflict contexts.


Internal contracting of health services in Cambodia: drivers for change and lessons learned after a decade of external contracting

ReBUILD paper on health contracting models in Cambodia since 2009. Includes lessons on the Special Operating Agencies model of contracting.


The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts

A paper from ReBUILD exploring the gendered experiences of health workers in fragile and post-conflict states


Changes in catastrophic health expenditure in post-conflict Sierra Leone: an Oaxaca-blinder decomposition analysis

A paper from ReBUILD examining how households’ exposure to financial risks through seeking healthcare evolved in post-conflict Sierra Leone.


Performance-based financing in three humanitarian settings: principles and pragmatism

A paper from ReBUILD’s study exploring how performance-based financing emerged and was adapted in three humanitarian settings.


The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe

This 2013 paper examines implications for human resources for health of changes in user fees for maternal and newborn health services in Zimbabwe.


Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study

A paper from ReBUILD’s study on health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’ s health system.


Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems

Literature review from ReBUILD by on how context affects performance-based health financing in fragile and conflict-affected settings.


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

ReBUILD paper examines health systems research that explored and evaluated health worker performance during crises in Sierra Leone & Nepal


Why do people become health workers? Analysis from life histories in four post‐conflict and post‐crisis countries

Paper from ReBUILD’s health worker incentives research looking at motivation to join the profession in Uganda, Sierra Leone, Cambodia & Zimbabwe.


How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia

Paper draws together lessons from ReBUILD’s research on health worker incentives in northern Uganda, Sierra Leone, Zimbabwe and Cambodia.


Resources from ReBUILD’s work on health financing in conflict-affected and post-conflict settings

Health financing in conflict-affected and post-conflict settings: Resources from ReBUILD’s work


The commercialization of traditional medicine in modern Cambodia

This 2017 paper describes the findings from ReBUILD’s research in Cambodia as part of the health financing research strand


Minding the gaps: health financing, universal health coverage and gender

This 2017 ReBUILD paper reflects on why we need to focus on gender when moving towards Universal Health Coverage


Leaving no one behind: lessons on rebuilding health systems in conflict and crisis-affected states

This paper draws on ReBUILD’s research to understand key issues inhibiting health systems strengthening in fragile settings


Sub-national assessment of aid effectiveness: A case study of post-conflict districts in Uganda

This 2017 paper reports on ReBUILD’s research in northern Uganda, undertaken to assess the aid-effectiveness in post-conflict districts of the country


Application of social network analysis in the assessment of organization infrastructure for service delivery: a three district case study from post-conflict northern Uganda

This 2017 paper reports on ReBUILD’s research on aid effectiveness in northern Uganda in the post-conflict reconstruction phase


Health systems research in fragile and conflict affected states: a qualitative study of associated challenges

This 2017 ReBUILD paper seeks an understanding of the challenges of conducting health systems research in fragile and conflict-affected settings


The role of women’s leadership and gender equity in leadership and health system strengthening

This 2017 paper from ReBUILD and the RinGs programme explores gender and leadership in the health sector focusing on Cambodia, Kenya and Zimbabwe


Gender equality needs critical consideration in conflict-affected settings

This 2015 ReBUILD paper argues that more attention should be focused on addressing gender inequalities and inequities in conflict-affected states


Building post-conflict health systems: a gender analysis from Northern Uganda

This book chapter analyses ReBUILD’s research in Northern Uganda to explore gender equity in the post-conflict reconstruction of the heath sector


Health systems research in fragile and conflict-affected states: a research agenda-setting exercise

This paper reports on a research needs setting exercise carried out by the HSG Thematic Working Group on Health Systems in Fragile and Conflict Affected States (TWG-FCAS).


Impact of health financing policies in Cambodia: A 20 year experience

This paper reports on some of the findings from ReBUILD’s quantitative research into post-conflict health financing policies in Cambodia.


Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building

This paper describes findings from a case study on the health system in Yobe state in northern Nigeria during the Boko Haram insurgency, part of the ReBUILD affiliate project on Health Systems Resilience: A Systems Analysis.


Experiences of using life histories with health workers in post-conflict and crisis settings: methodological reflections

This paper examines the ReBUILD programme’s experience of using life histories to explore health system trajectories coming out of conflict through the eyes of health workers. The paper shows how life histories with health staff can be a very powerful tool, particularly in contexts where routine data sources are absent or weak, and where health workers constitute a marginalized community.


Evolution of policies on human resources for health: opportunities and constraints in four post-conflict and post-crisis settings

This article draws on ReBUILD’s research on human resources for health across four post-conflict settings, shedding light on the patterns and drivers of post-conflict policy-making. It explores whether the post-conflict period offers increased chances for the opening of ‘windows for opportunity’ for change and reform and the potential to reset health systems.


Retention of health workers in rural Sierra Leone: findings from life histories

This article, published in Human Resources for Health, reports the findings from ReBUILD’s qualitative work in Sierra Leone on health worker incentives.


Using life histories to explore gendered experiences of conflict in Gulu District, northern Uganda: Implications for post-conflict health reconstruction

This article discusses how the life histories approach was used to explore how the 20-year conflict in northern Uganda transformed people’s lives. Presenting the experiences of 47 men and women before, during and after the war in northern Uganda, and how gender and power(lessness) shaped their experiences, it explores the implications for health care reconstruction.


Health worker experiences of and movement between public and private not-for-profit sectors – findings from post-conflict Northern Uganda

This paper looks at the experiences of health workers during and after the 20 years of conflict in northern Uganda, and the factors that influenced their movement between public and private not-for-profit sectors. The findings highlight the need to ensure balanced health labour market incentives which take into account not only the changing context but also needs at different points in individuals’ life cycles and across all core service delivery sectors.


Can positive inquiry strengthen obstetric referral systems in Cambodia?

This paper draws on ReBUILD’s Responsive Fund project “Obstetric Referral in the Cambodian Health System – What Works?” This project was conducted by the Nuffield Centre for International Health & Development, University of Leeds and Cambodian Development Research Institute.


Resources from ReBUILD’s work on health worker incentives in Sierra Leone, and on health worker experiences during the Ebola outbreak

Details of all outputs from ReBUILD’s work on health worker incentives and remuneration in Sierra Leone, and on health worker experiences during the Ebola outbreak.


Resources from ReBUILD’s work on health worker incentives and deployment in post-conflict and post-crisis settings

This document includes details of all outputs from ReBUILD’s work on human resources for health in post-conflict and post-crisis settings.


Performance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone

The study investigates the absolute and relative contribution of performance-based financing (PBF) to health workers’ income and explores their views on PBF bonuses, in comparison to and interaction with other incomes. The study confirms the complex and interrelated nature of health workers’ remuneration and that the different financial incentives cannot be examined independently from one. It also shows that the way PBF schemes are implemented has an impact on health worker motivation.


Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone’s free health care initiative

This paper reports the findings of a study evaluating the impact of Sierra Leone’s 2010 Free Health Care Initiative (FHCI). It uses two nationally representative surveys to identify the impact of the policy on utilisation of maternal care services by pregnant women and recent mothers as well as the impact on curative health care services and out-of-pocket payments for consultation and prescription in children under the age of 5 years.


Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone

This 2016 ReBUILD paper investigates the formal and informal payments available to health workers in Sierra Leone


Exploring the influence of context and policy on health district productivity in Cambodia

Despite gains in life expectancy and increased health expenditure, Cambodia still lags behind neighbours in many health indicators. This article aims to understand variations in efficiency of public health services, and the extent to which changes in efficiency are associated with key health policies that have been introduced to strengthen access to health services over the past decade.


Ebola in the context of conflict affected states and health systems: case studies of Northern Uganda and Sierra Leone

Ebola seems to be a particular risk in conflict affected settings. This paper compares the experience of Northern Uganda and Sierra Leone in the emergence and management of Ebola outbreaks in 2000-1 and in 2014-15 respectively, and how elements of these conflict affected societies affected the disease outbreak and the response.


Failing Adolescents: Social Control, Political Economy & Human Development in post-war Sri Lanka

In post-war societies adolescents occupy liminal spaces and present a particular challenge for post-war communities as well as service providers. This paper draws on a study from two war-affected villages in Sri Lanka, examining the multi-faceted challenges that adolescents face in communities attempting to retain and redefine boundaries, identities, and social and moral regulation in a post-war context.


An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone

This 2015 ReBUILD paper focuses on health worker incentives and payments in Sierra Leone and presents an exploration of district-level implementation processes


Fragile and conflict affected states: report from the Consultation on Collaboration for Applied Health Research and Delivery

Fragile and Conflict Affected States present difficult contexts to achieve health system outcomes and are neglected in health systems research. This report presents key debates from the Consultation of the Collaboration for Applied Health Research and Delivery, Liverpool, June, 2014.


Human resource management in post-conflict health systems: review of research and knowledge gaps

Effective human resource management strategies and policies are critical to addressing systemic effects of conflict on the health workforce. This paper reviews published literatures across three functional areas of HRM in post-conflict settings: workforce supply, workforce distribution, and workforce performance.


Health systems and gender in post-conflict contexts: building back better?

This narrative literature review is an output of collaborative work between ReBUILD and the Stockholm International Peace Research Institute (SIPRI) working group on gender, to explore the opportunities and challenges for building gender responsive health systems in post conflict contexts.


A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002–2012

This paper draws on ReBUILD’s research to look at the development of policies on human resources for health (HRH) in Sierra Leone over the decade after the conflict (2002–2012).


State-building and human resources for health in fragile and conflict-affected states: exploring the linkages

Whilst human resources for health are self-evidently critical to running a health service and system, this paper explores a broader issue of the contribution which health staff might play in relation to the wider state-building processes.


The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives

This paper argues that research focusing on the health workers’ “complex remuneration” is critical to address some of the most challenging issues affecting human resources for health. An empirical research agenda is proposed to fill the gap in our understanding.


Health worker incentives: survey report, Sierra Leone

A 2015 RBUILD report on the need to reach and maintain incentive environments for health workers to support access to equitable health services


The free health care initiative: how has it affected health workers in Sierra Leone?

In this paper published in Health Policy and Planning, ReBUILD researchers Sophie Witter, Haja Wurie and Maria Bertone explore the effects and implications for health staff of Sierra Leone’s introduction in 2010 of the Free Health Care Initiative (FHCI).


Health financing in fragile and post-conflict states: What do we know and what are the gaps?

As part of ReBUILD’s wider work on health financing, this paper presents an exploratory literature review to analyse the themes and findings of recent writing on health financing in fragile and post-conflict settings.


Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems

This article presents the experiences of health workers who lived through decades of conflict in four districts of northern Uganda. It is based on in-depth interviews, using a life history approach, conducted as part of ReBUILD’s wider work on health workers’ experiences, motivation and incentives during and after conflict.