title: Evolution of policies on human resources for health: opportunities and constraints in four post-conflict and post-crisis settings.
abstract: BACKGROUND
  Few studies look at policy making in the health sector in the aftermath of a conflict or crisis and even fewer specifically focus on Human Resources for Health, which is a critical domain for health sector performance. The main objective of the article is to shed light on the patterns and drivers of post-conflict policy-making. In particular, we explore 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.
  
  
  METHODS
  This article uses a comparative policy analysis framework. It is based on qualitative data, collected using three main tools - stakeholder mapping, key informant interviews and document reviews - in Uganda, Sierra Leone, Cambodia and Zimbabwe.
  
  
  RESULTS
  We found that HRH challenges were widely shared across the four cases in the post-conflict period but that the policy trajectories were different - driven by the nature of the conflicts but also the wider context. Our findings suggest that there is no formula for whether or when a 'window of opportunity' will arise which allows health systems to be reset. Problems are well understood in all four cases but core issues - such as adequate pay, effective distribution and HRH management - are to a greater or lesser degree unresolved. These problems are not confined to post-conflict settings, but underlying challenges to addressing them - including fiscal space, political consensus, willingness to pursue public objectives over private, and personal and institutional capacity to manage technical solutions - are liable to be even more acute in these settings. The role of the MoH emerged as weaker than expected, while the shift from donor dependence was clearly not linear and can take a considerable time.
  
  
  CONCLUSIONS
  Windows of opportunity for change and reform can occur but are by no means guaranteed by a crisis - rather they depend on a constellation of leadership, financing, and capacity. Recognition of urgency is certainly a facilitator but not sufficient alone. Post-conflict environments face particularly severe challenges to evidence-based policy making and policy implementation, which also constrain their ability to effectively use the windows which are presented.
authors.affiliation: ReBUILD and Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Witter
authors.affiliation: Department of Global Health and Development & ReBUILD Consortium, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Bertone
authors.affiliation: ReBUILD and Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Yotamu
authors.initials: Y
authors.lastname: Chirwa
authors.affiliation: 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 and Cambodian Development Resource Institute, Phnom Penh, Cambodia.
authors.forename: Sovannarith
authors.initials: S
authors.lastname: So
authors.affiliation: ReBUILD Consortium and College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
authors.forename: Haja R
authors.initials: HR
authors.lastname: Wurie
keywords: Cambodia; Health workers; Human resources for health; Policy analysis; Post-conflict; Sierra Leone; Uganda; Zimbabwe