Witter Sophie, Namakula Justine, Alonso-Garbayo Alvaro, Wurie Haja, Theobald Sally, Mashange Wilson, Ros Bandeth, Buzuzi Stephen, Mangwi Richard, Martineau Tim
Professor of International Health Financing and Health Systems, ReBUILD and Queen Margaret University, Edinburgh, UK.
Research Fellow, ReBUILD and Department of Health Policy, Planning and Management, Makerere School of Public Health, Kampala, Uganda.
Health Policy Plan. 2017 May 1;32(4):595-601. doi: 10.1093/heapol/czw166.
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.
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.
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.
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).
生活史是一种研究工具，主要用于社会学和人类学，以记录边缘化个人和社区的经历。在卫生系统研究方面，对其探索较少。在本文中，我们通过卫生工作者的视角，审视我们利用生活史来探索冲突后卫生系统轨迹的经验。
生活史被用于四个相互关联的项目，这些项目涉及卫生工作者激励措施、埃博拉对卫生工作者的影响、部署政策以及卫生部门的性别与领导力。在乌干达、塞拉利昂、津巴布韦和柬埔寨，总共对244名不同级别的卫生工作者进行了访谈。生活史是混合方法研究中的一个要素。
我们审视了所面临的挑战以及应对这些挑战的方式。挑战出现在获取研究对象、数据收集以及分析和呈现生活史研究结果等方面。获取研究对象方面的挑战包括对该方法缺乏了解、不愿透露非常个人化的信息和情感、对保密性缺乏信任（尤其是考虑到创伤背景），以及在某些情况下，对研究及其改善工作生活潜力的怀疑态度。在数据收集方面，绘制生命线的意愿各不相同，并且有些人不愿提及敏感话题，特别是在与政策相关的问题和合法性仍普遍存在争议的背景下。在不损害保密性的情况下呈现生命线数据也是一个伦理挑战。
我们讨论了这些挑战如何（在很大程度上）得以克服，并得出结论，与卫生工作人员进行生活史研究可以成为一种非常有力的工具，特别是在常规数据来源缺失或薄弱，以及卫生工作者构成边缘化群体的情况下（中级干部以及在偏远地区工作的人员和经历过冲突与危机的工作人员通常就是这种情况）。
