Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems
Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems
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DOI：
10.1093/heapol/czu022
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发表时间：
2014-10-01
影响因子：
3.2
通讯作者：
Witter, Sophie
中科院分区：
文献类型：
--
作者：
Namakula, Justine;Witter, Sophie
提供以人为本的卫生系统--或任何系统--需要采取具体措施，在冲突期间和冲突后保护和留住医护人员。这一点尤其重要，因为卫生工作人员本身就是暴力和绑架的目标，这是经常发生的情况。这篇文章介绍了乌干达北部四个地区--帕德尔、古鲁、阿卢鲁和基特古姆--经历过冲突的卫生工作者的观点。其中90%以上的人因2006年结束的数十年冲突而流离失所。这篇文章基于26次深度访谈，采用了生活史的方法。这一参与性工具鼓励参与者记录他们生活中的关键事件和决定，并探索他们成为一名卫生工作者的决定、他们的就业史以及他们在冲突和应对战略方面的经历。对这些问题进行了专题分析，以加深对如何在这些具有挑战性的情况下保护和留住工作人员的理解。在冲突期间，许多卫生工作者失去了生命，或目睹了他们的朋友和同事的死亡。他们还经历了绑架、伏击和受伤。其他挑战包括与社会和专业支助系统脱节、流离失所、用品和设备有限、工作量增加、工作时间长以及缺乏工资。然而，面对这些挑战，卫生工作者并不被动。他们采取了一系列的安全措施，除了心理和实际的应对策略外，还采取了与社区成员打成一片、睡在灌木丛中、经常更换睡觉地点等安全措施。了解他们的动机和观点有助于深入了解如何维持人员配置，从而在困难时期和边缘化地区继续提供基本保健服务。
Providing people-centred health systems-or any systems at all-requires specific measures to protect and retain healthcare workers during and after the conflict. This is particularly important when health staff are themselves the target of violence and abduction, as is often the case. This article presents the perspective of health workers who lived through conflict in four districts of northern Uganda-Pader, Gulu, Amuru, and Kitgum. These contained more than 90% of the people displaced by the decades of conflict, which ended in 2006. The article is based on 26 in-depth interviews, using a life history approach. This participatory tool encouraged participants to record key events and decisions in their lives, and to explore areas such as their decision to become a health worker, their employment history, and their experiences of conflict and coping strategies. These were analyzed thematically to develop an understanding of how to protect and retain staff in these challenging contexts. During the conflict, many health workers lost their lives or witnessed the death of their friends and colleagues. They also experienced abduction, ambush and injury. Other challenges included disconnection from social and professional support systems, displacement, limited supplies and equipment, increased workload and long working days and lack of pay. Health workers were not passive in the face of these challenges, however. They adopted a range of safety measures, such as mingling with community members, sleeping in the bush, and frequent change of sleeping place, in addition to psychological and practical coping strategies. Understanding their motivation and their views provides an important insight how to maintain staffing and so to continue to offer essential health care during difficult times and in marginalized areas.