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Health worker experiences of and movement between public and private not-for-profit sectors—findings from post-conflict Northern Uganda
© Namakula et al. 2016
Received: 17 August 2015
Accepted: 25 April 2016
Published: 5 May 2016
Northern Uganda suffered 20 years of conflict which devastated lives and the health system. Since 2006, there has been investment in reconstruction, which includes efforts to rebuild the health workforce. This article has two objectives: first, to understand health workers’ experiences of working in public and private not-for-profit (PNFP) sectors during and after the conflict in Northern Uganda, and second, to understand the factors that influenced health workers’ movement between public and PNFP sectors during and after the conflict.
A life history approach was used with 26 health staff purposively selected from public and PNFP facilities in four districts of Northern Uganda. Staff with at least 10 years’ experience were selected, which resulted in a sample which was largely female and mid-level. Two thirds were currently employed in the public sector and just over a third in the PNFP sector. A thematic data analysis was guided by the framework analysis approach, analysis framework stages and ATLAS.ti software version 7.0.
Analysis reveals that most of the current staff were trained in the PNFP sector, which appears to offer higher quality training experiences. During the conflict period, the PNFP sector also functioned more effectively and was relatively better able to support its staff. However, since the end of the conflict, the public sector has been reconstructed and is now viewed as offering a better overall package for staff. Most reported movement has been in that direction, and many in the PNFP sector state intention to move to the public sector. While there is sectoral loyalty on both sides and some bonds created through training, the PNFP sector needs to become more competitive to retain staff so as to continue delivering services to deprived communities in Northern Uganda.
There has been limited previous longitudinal analysis of how health staff perceive different sectors and why they move between them, particularly in conflict-affected contexts. This article adds to our understanding, particularly for mid-level cadres, and highlights 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.
KeywordsHealth workers Public sector Private not-for-profit Uganda Post-conflict Attraction Retention
The conflict in Northern Uganda between the Uganda army and the Lord’s Resistance Army (LRA) rebel group lasted for 20 years (1986–2006). This resulted in loss of lives, mass displacement (within and outside the region) for ordinary people and the health workforce, discontinuation of social services and destruction of infrastructure such as roads, schools and health facilities [1–3]. At the end of the conflict, the health system was split into a functional camp-based health system run by international agencies and non-governmental organisations (NGOs), on the one hand, and a few government health facilities confined to towns or in protected areas on another . The rest of the government-owned health facilities had been destroyed and remained dysfunctional without supplies. The private not-for-profit (PNFP) sector also played an important role in filling the gap in health service delivery, particularly in very remote areas and in times of epidemics such as Ebola and cholera [5, 6]. The Uganda Catholic Medical Bureau (UCMB), for example, owns 22 % of health facilities in Northern Uganda .
Since 2006, more than 85 % of internally displace persons (IDPs) living in camps are reported to have returned to their villages of origin or moved to transit/satellite camps closer to their homes . Although this resettlement has been gradual, it has raised issues of access and equity as well as the need for health system and human resources for health reconstruction .
In Northern Uganda, reconstruction efforts are coordinated under the overarching framework of the Peace and Recovery Development Plan (PRDP 2007). These reconstruction efforts have included the strengthening of local government capacity and rehabilitation of critical infrastructure such as health facilities and roads . However, there are still challenges for HRH which are common on post-conflict settings , such as poor skill mix, geographical imbalance and difficulties in attraction of health workers.
Public and PNFP sectors both play a significant role in health service delivery in post-conflict Northern Uganda. However, there is a risk that they compete with one another for a limited supply of qualified staff. With improvements in the terms and conditions in the public sector, the PNFP sector is perceived to be suffering from increased attrition, especially in key clinical cadres and at the hospital level .
The effects of health worker movement between sectors include the creation of inequities for the population served by the sectors and the weakening of health systems, as some sectors are left with fewer health workers [12, 13]. The situation can even be worse for post-conflict settings where the populations are concentrated in rural areas and where attracting and retaining staff can be particularly difficult [14–16].
Understanding the movement of health workers between public and PNFP sectors is vital to ensure that both are able to contribute to universal health coverage post-conflict and to health system resilience in the face of future conflicts, epidemics and other shocks. Few studies have focused on health workers’ experiences of different sectors over time, in conflict and post-conflict contexts.
This article has two objectives: first, to understand health workers’ experiences of working in public and PNFP sectors during and after the conflict in Northern Uganda, and second, to understand the factors that influenced health workers’ movement between public and PNFP sectors during and after the conflict.
This was a phenomenological qualitative study which mainly employed the life history method to enable the research team to acquire in-depth information and to capture a trajectory of health workers’ experiences and movement between sectors across their careers and across the different phases of conflict.
The creation of time lines by the participants enabled their active participation in the research process and also iterative probing on key events (as perceived by individual health workers) and decisions made by health workers across their career paths and conflict phases.
Site and sample selection
Characteristics of participants
Time spent working in the region
23 % M, 77 % F
Clinical officers (15.38 %), nurses (57.68 %), nursing assistants (7.69 %), midwives (11.53 %), others (7.68 %)
27 % Pader, 27 % Kitgum, 19 % Amuru, 31 % Gulu
65 % public, 35 % PNFP
Type of health facility
Hospitals (31 %), HC IV (15 %), HC III and II (46 %), others (8 %)
Highest level of formal education
69 % O’Levelb, 12 % A’levelb, 15 % diploma, 4 % degree
Fieldwork was conducted in October 2012. A life history approach was adopted. During the interview, a horizontal line was drawn on a piece of paper, and with assistance from the interviewer, participants were encouraged to record key events and decisions in their lives along the line. Probes were made about the decision to become a health worker, training experiences, their employment history, why they had stayed or moved between jobs, their job satisfaction, experience of conflict, coping strategies during and after conflict and experience of different policies and future plans, including intentions to move. The life line was used as a tool to guide discussion, and at the end of the interview, it provided a visual representation/summary of key events, as perceived by the participant. The findings discussed in this paper will be focused on the movement of health workers between public and PNFP sectors and the factors driving their movement between the sectors during and after the conflict.
Ethical approval clearance was granted by the Makerere University School of Public Health Higher Degrees Research and Ethics Committee and by the Uganda National Council for Science and Technology and the Research Ethics Committee at the Liverpool School of Tropical Medicine in 2012.
Data analysis was guided by the framework analysis approach of Ritchie and Spencer  and analysis framework stages provided by Ritchie and Lewis . ATLAS.ti software version 7.0 was used to manage the data. Audio tapes were listened to and compared with notes taken during interviews to fill in the gaps in information that could have been left out or miss-recorded during note taking. Audio recordings were transcribed verbatim so that original meanings are not lost. Transcripts were read several times to get an overall picture, and then, recurring preliminary themes were identified and used to create codes.
A code book was generated, and data were then prepared for entry into ATLAS.ti by filing transcripts using identifiers such as district, current sector of employment, level of health facility, cadre and gender. Filed transcripts and codes were then uploaded into ATLAS.ti, and coding nodes were attached to quotations. ATLAS query reports were generated and printed out for each code and further familiarised to identify more sub-themes. Similar sub-themes were merged together to create themes, whereas in some cases, sub-themes were created. These themes were further entered into pivot tables with each respondent anonymised as a personal identification (PID) number. Finally, quotations that epitomised the emerging themes were identified and agreed upon by the research team. Selected quotes were labelled according to PID, gender, sector of employment and district. Life lines were used as guides during interviews and also to aid analysis of patterns of movement. The life lines are not included in the article for confidentiality reasons, as the information in them can reveal individual identities.
We present findings which follow the logic of the life history. We first discuss initial training experiences, as these are presumed to influence subsequent decisions to stay or leave a sector. We then present their subsequent working experiences during and after the conflict, focusing on their experiences of differences between the sectors. Next, we present factors reported to influence their decision to move or not between public and PNFP sectors as well as their future intention to move.
Health workers’ experiences of public and PNFP sectors at initial training
A total of nine training institutions were mentioned by participants as places where they had their first (initial) training in medical skills, mostly during the conflict period. The majority of the participants had their initial training in nursing schools within missionary (PNFP) hospitals located within the greater Northern Uganda. Fewer participants had their training in government-owned training institutions located within the greater Northern Uganda region or outside the region.
The themes discussed under training experiences related to management of training facilities, quality of teaching experienced, workload and incentives.
Management of training facilities
In relation to management, there were reported differences between the PNFP sector and public sector. Compared to the public sector, the training institutions under PNFP were reported to be characterised by more strict management styles reflected in various restrictions.
[…] as students during that time, we were being restricted not to go out or any here beyond the hospital. […] you are not allowed to go out unless you have been permitted and you are supposed to go out once a month. PID 24 Male, PNFP, Pader
[…] I tell you the principal was too strict! We used to have few boys but now they are many. So there was a lab where boys and girls met, as you know the adolescent age, they could relate […]. When you see her (the principal) coming at a distance you must run […]. PID 11 Female (but trained in the PNFP sector), Public, Kitgum
Quality of training
During the training time, it was very good because we had a British tutor called miss JXX who was very good, very motherly and gave us all the basics in the training, i.e. the skills, knowledge and during practicals she was with us, what she has taught she could follow us up to the ward and say that you are performing the real thing on the ground. PID 12 Female, PNFP, Kitgum
My experience in XX (public) training school of Nursing, first we didn’t have good tutors […] you had to struggle on your own so I had my sister who had already completed in Training school xx [a PNFP institution], […] she helped me with her notes […] They could rarely come to teach us […]. PID 9 Female, Public, Kitgum
[…] otherwise when you join for the first three weeks, you are taught many things before you can go to the ward. So you end up with a lot of experience because they have a lot of materials. PID 11 Female, Public, Kitgum
[…] working in a missionary hospital is really good because there you are exposed to so many cases, you see cases and then they motivate you in very many ways because you see how it is done in reality. PID 16 Female, Public (but trained in the PNFP sector), Amuru
Workload during training
The training was o.k. only that because of the insurgency […] we had a lot of experience you [could] find a full track of soldiers being brought with injuries so the students have to be taken on the ward to work on them, we had too much work that time though we were still students but there was no option we had to work on the victims. PID 15 Female, Public, Gulu
During those days, during Ebola outbreak [2000–2001], it was not easy because we had many patients […] it was such a scary thing for us. In most cases, we were working on rebels themselves. But we had our teachers who were counsellors and so the fear disappeared […]. PID 2 Female, PNFP, Amuru
Incentives received during training
At the end of the month they could give us [all students] sugar, and also a bar of washing soap, some little money,[…] it was 12,000/=[ in 1978] [[…]. PID 23 Female, PNFP, Pader
[…] in 1998, I was XX public training institution sponsored by the HSSP programme at the district. It was quite hard […] my father could send some little money for up keep, the institution[public] used not to give us any allowance so you were to find your level. PID 26 Female, Public, Pader
From 1999 up to 2002 I trained from XX PNFP institution as a Nursing aide. […] life was so fine because, we were being fed as students. PID 18 Female, PNFP, Amuru
Health workers’ subsequent job experiences in PNFP and public sectors
Health workers’ subsequent experiences working in the PNFP and public sectors were mainly differentiated by working conditions. Working conditions may include many parameters, but participants focused on management and leadership, workload and working hours, and incentives.
Management and leadership
Health workers in the PNFP sector encountered more restrictions during their subsequent job postings compared to those who worked in the public sector. Whereas at the initial training, restrictions in the PNFP sector concentrated around relationships, movements outside the hospital environment and general behaviour, for the subsequent jobs, the previous restrictions still held but new ones were reported to be introduced. These new restrictions were related to zero tolerance on dual practice (particularly for medical work), whereas within the public sector, there were regulations but some flexibility. Additionally, compared to the public facilities, the PNFP facilities showed a continued strictness on time management.
[…] So here [at PNFP facility] we come right in time but in government whether you come on duty [in time] or not your salary will be there you see? […]. Some people [health workers] are running small business like selling these second hand clothes. […] after work […] but what they don’t want is selling drugs. PID 12, Female, PNFP, Gulu
I have a drug shop to help me supplement my income […] But there are lots of restrictions [in public sector], the district comes with their policies and the government with their own also that we should not be having these drug shops or clinics. PID 25, Male, Public, Pader
This hospital (public facility) was being strongly supported by Italians by that time[of the war] but eventually when they were leaving […] they had nurtured the African doctors to take over […] and these remained wonderfully working but the working conditions continued to be very hard. PID 6 Female, Public, Kitgum
When you go for study leave they give us 40,000/= as pocket money per month but in the government they give full salary. So if you have a family like mine you cannot do anything with that 40,000/= per month […]. PID 24 Male, PNFP, Pader
During those days, during Ebola outbreak, it was not easy because we had many patients […]. PID 2 Female, PNFP, Amuru
Yeah, during […] the war times […] around June-august 2002 […]we would work all night, we were having casualties, two lorries […] we started working from 6.00 p.m. to around 4.00 a.m. […] then the following day from 11.00am to midnight […]. PID 24 Male, PNFP, Pader
The number of patients was overwhelming, because all these five refugee camps, I think about 13,000 people were being served by 2 health centres […] too many injuries. PID 25 Male, Public, Pader
[…] then I worked in [Outpatients’ department] OPD of Atapara missionary hospital. Eeeh! […] to be sincere we could work […] you know being a missionary hospital in that area […] we had very many patients […]. PID 16 Female, Public, Amuru
Salaries, allowances and incentives
The work was okay, but the problem was no money, […] at that time I was not on salary. They were giving us some allowances when we go for outreaches, and the NGOs who were on the ground would motivate us plus risk allowance during the period of Ebola [2000–2001]. PID 12 Female Public, Gulu
[When I finished training and was retained in Lacor] it [the salary] was little- I think it was 150,000, 170,000. […] the good thing […] they had given us accommodation and were paying for our electricity and we had water in the hospital […]. PID 11 Female Public, Kitgum.
In XX PNFP facility, we started with something small in terms of salary, but they have increased and I can’t really compare because I don’t have at hand what my colleagues in the government have. But the only good part is that normally our salaries don’t delay, they pay us really in time. PID 19 Female PNFP, Gulu
[…] posted to XX public Health centre in 2000 but no salary for 6 months. […] Surviving on allowances from MSF Spain. PID 16 Female Public, Amuru
[…] right from the first, second and all the jobs that I was being transferred to, I still received the hard to reach allowance. It’s of recent because of decentralization that they have chopped off yet this place is still a hard to reach place […]. PID 25 Male Public, Pader
[…] we do not get hard to reach allowance […]. PID 18 Female PNFP, Kitgum
That is why the rate of retention of staff in NGOs is less because we work minus those consolidated lunch allowances […]. We are depending on donors. PID 12 Female, PNFP, Gulu
Yes, in comparison with XX PNFP hospital, where the staff get free medical treatment here, we are given a pre-paid card worth 80,000/= which we can use for treatment […] If you use up all the money, then you have to top up with your own money. PID 24 Male PNFP, Pader
We have been given accommodation, there is light (power), there is water and if you are not well, treatment is free inclusive of your children, husband and parents. We are provided with that free medical service. PID 12 Female PNFP, Gulu
Other factors influencing health workers’ movement between public and PNFP sectors
We fled to Angal Hospital [in Nebbi district, West Nile sub-region] from Kalongo due to Insurgency. PID 7 Female, PNFP, Kitgum
Given that the [war] situation was horrible, I abandoned the job at Kitgum hospital and went to stay in Kampala for 2 years […]. PID 26 Female, Public, Pader
[…] until 1986 when […]the rebels over ran the place […] we ran together with the soldiers, […] I stayed in the village a bit because coming to town was a bit of a problem […], […] I went to town in 1987 and started working in Kitgum general hospital. PID 22 Male, Public, Pader.
[…] in 2002, I got a vacancy at Kitgum hospital [public] on contract under an NGO. PID 26 Female, public, Pader
What made me leave that job [in PNFP] in 2001 was because […] government gives […] pension when you reach retirement age […]. Also […] when you lose your mother, missionary hospitals give you only two days. […] but in government […] you get a one week for you to at least mourn and come back when you are fresh. PID 11 Female, Public, Kitgum
[…] my first job [in PNFP] was interesting. […] however, the work was too much and […] no freedom, you wouldn’t have any hour of doing your own things because every time you are supposed to be on duty! [..] Life became very difficult and so in  I applied to government service commission when they advertised, passed the interview and got the job […]. PID 16 Female, Public, Gulu.
I worked at XX PNFP Hospital for 20 years without transfer. Although I was sponsored [by the PNFP hospital] for a public Health course for one year […] promoted on return […] and paid well. […] What made me come to Local Government [in 2011] was because […] I was not practicing my new skills as a public health nurse [at the PNFP facility]. […] therefore I applied to local government. PID 13 Female, Public, Gulu
[…] at the PNFP facility[where I worked] there was lot of conflict in the nurses’ quarters, so I first abandoned the hospital accommodation and went to stay outside[the hospital] but then I ended up spending almost all my salary on transport and so I decided to leave PNFP to government. So, [in 2008] I applied in 2008 and got the government job. PID 19 Female, Public, Gulu
War broke out and there was massive displacement in 1987–1988. We moved from Kalongo to Adilang sub-county in West Nile and [in 1988] that was when I joined local government. PID 20 Female, Public, Pader
[…] in 1999, I left Kitgum general hospital [public] and moved to Kalongo [PNFP] because I was uncomfortable I had been separated from my husband and family and wanted to be with them. PID 22 Female, PNFP, Pader
Reasons for not moving between sectors
In some cases, health workers never moved between sectors. Some health workers were rotated within departments in the same facility of the same sector in the same district, whereas others were not rotated but merely promoted. On average, these health workers worked in the same facility for 27 years.
[…] after exams in November they [hospital] also called me back to come and work here. […] if they [the hospital administration] sponsor you, you have to comeback straight here and work. You cannot go anywhere […]. PID 24 Male PNFP Pader
[…] There was [and there still is] free health care for staff and family. PID 1 PNFP, Kitgum
[…] everything was paid by the Ministry of Health and I was very grateful. That is why I am very happy and I am serving here in the village because without that sponsorship from the ministry, I would not have managed. […] that is why I have continued and will never withdraw from the district because it was a nice beginning, a foundation. PID 9 Female Public, Gulu
[…] So war came and got us here and of course the war scattered most of the staff, […] People had to run to save their lives […] I had the spirit that I am better off dying from my workplace and that encouraged me to stay. PID 6 Female Public, Kitgum
Future intention to move
The health workers were also asked about their intention to move from one sector to another in their later career stages and the reasons why. Although there was intent to move from PNFP to public and within both sectors, none of the health workers expressed an intention to move from public to PNFP.
[…] there is no job security here. Staff is on an annual contract. PID 1 Male PNFP, Kitgum
[…] we have a lot of work. […] If you‘re in government, you have a very big chance of going for workshop […]. PID 24 Male PNFP, Pader
The study utilised the life history tool which was found effective in understanding health workers’ embedded experiences of sectors of employment during and post-conflict. The health workers involved were largely mid-level and female, which reflects the composition of the health workforce in this area. A recent study found that 77 % of health workers in Northern Uganda were female .
Summary of findings
Quality of training
Good tutors but some absences
More limited clinical exposure
Good and present tutors
Good exposure to clinical experience
Wider range of incentives, including financial
Limited (mainly non-financial) incentives
Management and organisational culture
Perceived greater flexibility about leave arrangements
Exposure to expatriate (NGO) staff—appreciated—especially during conflict
More restrictions (e.g. on dual practice and time management)
Exposure to expatriate (missionary) staff, with positive effects on learning, especially during conflict
High workload in IDP camps
High workload during and after conflict—but helps to maintain skills
Low salaries, especially important later in middle of life cycle; irregular or absent during conflict; various coping strategies described
Benefit from monetary incentives such as consolidated allowance and hard to reach allowance
Low salaries, especially important in middle of life cycle; various coping strategies described
Only access short-term, externally funded monetary incentives
Package of non-financial incentives, which vary across facilities
Reasons for moving, staying and factors influencing future intentions
Better overall package—leave, pension, allowances, higher salary
Flexibility on leave and dual practice
Able to exercise skills better
Better job security
More access to training
Bonding (but sometimes perceived as detention)
Good working relationships and ties of family obligation
Availability of free health care for them and their families
Loyalty to sector which trained you
Frequent short trainings
Strict rules on dual practice/inflexibilities on leave
Perceived high work load
No job security (mainly contractual)
Limited access to training
The findings highlight that the PNFP sector plays a dominant role in initial training, at least in the Acholi region. This is because it owned the majority of the training institutions in the region and attracted many health workers to its schools due to incentives provided, ways of teaching and practical experiences. This and related bonding practices encouraged some workers to stay long term in the PNFP sector; however, some health workers perceived bonding as coercive and referred to it as ‘detention’.
During the conflict, the PNFP sector remained more functional, including in terms of supporting staff with pay. Although workload was high, the sector was able to retain staff, but when the public sector re-established itself post-conflict and was able to offer better terms and conditions, the competition for staff became more intense.
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.
The PNFP sector has endeavoured to mitigate the problem through a number of strategies which include more recruitment, attempts to increase salaries, having health workers seconded by the government and training of managers to improve their skills . Nevertheless, the extent to which both financial and non-financial interventions helps manage movement from the PNFP to the public sector cannot easily be ascertained .
The study also found that incentive structures influence the migration of health workers differently at different stages of their careers. For example, the PNFP sector has a good system for training to the extent that in some literature it has been referred to as the ‘internship centre’ . However, in the later stages of their careers, health workers aspire to pensionable jobs, security and monetary benefits as opposed to in-kind benefits. The tendency is to move to the public sector is to seek these benefits. This needs to be taken account of when planning for stabilisation of the workforce in both sectors. For instance, the PNFP sector may have to consider establishing pensionable jobs and monetized benefits for cadres with increasing family responsibilities. Lessons can be learnt from countries like Zambia and Ghana where the government provides salaries and pensions for both the public and PNFP sectors .
Our findings are consistent with some previous studies in Uganda [20, 22–24]. However, some have argued that the total remuneration package for PNFPs is by far better than that of the public sector, particularly for doctors, although the biggest portion comprises non-financial incentives . In other African countries such as Tanzania, movement between public and PNFP has also been triggered by perceived better payment and benefit packages in the former [25–27]. In Namibia, movement to the public sector was attributed to the presence of fringe benefits and better conditions of service . Salary differentials have also been found to affect health worker migration and retention between sectors in Zambia, Ghana, Malawi and Ethiopia . In general, however, studies tend to find better pay and conditions in the PNFP sector relative to the public , which is the converse of our findings for Uganda.
The general expectation, or hypothesis, that the PNFP sector will be characterised by better pay and working conditions (often with more international support), offset by stricter management and sustained by more altruistic behaviour , is only partially supported by our evidence. Certainly in relation to terms and conditions, the PNFP sector is no longer competitive in Northern Uganda. Workplace factors which would enhance loyalty are also less effective than might have been expected, with some management in the PNFP sector particularly experienced as hierarchical and unsupportive. Some of Herzberg’s motivators , such as feeling recognised and being given promotion as reward for achievements, are not being sufficiently deployed to offset these difficult terms and conditions.
The study was conducted in four districts of the Acholi sub-region and with a selection of health workers who met the selection criteria of ‘at least 10 years and above’; hence the study findings may neither be generalised to all health workers within the region nor to the rest of Uganda. This was a positive deviance study in that it only focused on those who stayed in the region and not those who left the region. The study was also based largely on the experiences of mid-level cadres, as they were the ones who had stayed working in the region over time. The largely female composition of the workforce influenced the gender balance of the final sample. No private sector staff were interviewed as provision of private health care is limited in remote rural areas of Northern Uganda. Additionally, given the limited space, the paper does not cover discussion of difference between the sectors in terms of motivation to join the profession, although these may have a bearing on subsequent experiences and choices.
The study has highlighted that health worker experiences of and movements between sectors are dynamic and complex, affected by contextual changes, such as conflict, life cycle issues for health workers and also policy changes, such as changing allowances. Incentive policies to attract and retain health workers need to take these into account. In post-conflict areas like Northern Uganda where the PNFP sector continues to play an important service delivery role, attention needs to be paid to making their terms and conditions more competitive relative to the public sector. Interventions to stabilise numbers of health workers, particularly the nurses and midwives, to match the needs at all levels of the health system in both sectors require comprehensive and participatory development and assessment.
This study is part of the ReBUILD health worker incentives research project. The project aimed to understand the evolution of incentives for health workers post-conflict and to derive policy recommendations for improving retention in those areas. The ReBUILD consortium is funded by the UK Department for International Development.
The views expressed do not necessarily reflect the UK government's Official policies.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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