title: Experiences of using life histories with health workers in post-conflict and crisis settings: methodological reflections.
abstract: BACKGROUND
  Life history is a research tool which has been used primarily in sociology and anthropology to document experiences of marginalized individuals and communities. It has been less explored in relation to health system research. In this paper, we examine our experience of using life histories to explore health system trajectories coming out of conflict through the eyes of health workers.
  
  
  METHODS
  Life histories were used in four inter-related projects looking at health worker incentives, the impact of Ebola on health workers, deployment policies, and gender and leadership in the health sector. In total 244 health workers of various cadres were interviewed in Uganda, Sierra Leone, Zimbabwe and Cambodia. The life histories were one element within mixed methods research.
  
  
  RESULTS
  We examine the challenges faced and how these were managed. They arose in relation to gaining access, data gathering, and analysing and presenting findings from life histories. Access challenges included lack of familiarity with the method, reluctance to expose very personal information and sentiments, lack of trust in confidentiality, particularly given the traumatized contexts, and, in some cases, cynicism about research and its potential to improve working lives. In relation to data gathering, there was variable willingness to draw lifelines, and some reluctance to broach sensitive topics, particularly in contexts where policy-related issues and legitimacy are commonly still contested. Presentation of lifeline data without compromising confidentiality is also an ethical challenge.
  
  
  CONCLUSIONS
  We discuss how these challenges were (to a large extent) surmounted and conclude that 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 (as is often the case for mid-level cadres, those serving in remote areas, and staff who have lived through conflict and crisis).
authors.affiliation: Professor of International Health Financing and Health Systems, ReBUILD and Queen Margaret University, Edinburgh, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Witter
authors.affiliation: Research Fellow, ReBUILD and Department of Health Policy, Planning and Management, Makerere School of Public Health, Kampala, Uganda.
authors.forename: Justine
authors.initials: J
authors.lastname: Namakula
authors.affiliation: ReBUILD, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso-Garbayo
authors.affiliation: Health Systems Researcher, ReBUILD Consortium and College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown.
authors.forename: Haja
authors.initials: H
authors.lastname: Wurie
authors.affiliation: Social Science and International Health, ReBUILD and RinGS consortia, Liverpool School of Tropical Medicine, Liverpool, UK.|Institute of Development Studies, Sussex, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Theobald
authors.affiliation: ReBUILD and Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Wilson
authors.initials: W
authors.lastname: Mashange
authors.affiliation: ReBUILD and RinGS consortia, Cambodian Development Resource Institute, Phnom Penh, Cambodia.
authors.forename: Bandeth
authors.initials: B
authors.lastname: Ros
authors.affiliation: Public Health Researcher, ReBUILD and RinGS consortia, Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Stephen
authors.initials: S
authors.lastname: Buzuzi
authors.affiliation: ReBUILD and Department of Health Policy, Planning and Management, Makerere School of Public Health, Kampala, Uganda.
authors.forename: Richard
authors.initials: R
authors.lastname: Mangwi
authors.affiliation: Rebuild and Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Martineau
mesh_terms: D000349:Africa; D000068337:Armed Conflicts / Q000523:psychology*; D002160:Cambodia; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D009042:Motivation; D036301:Qualitative Research
keywords: Health workers; life histories; post-conflict; qualitative methods