What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal

Background: Health workers are critical to the performance of health systems; yet evidence about their coping strategies and support needs during and post crisis is lacking. There is very limited discussion about how research teams should respond when unexpected crises happen during on-going research. This paper critically presents the approaches and findings of two health systems research projects which explored and evaluated health worker performance and were adapted during crises; and provides lessons learnt on re-orientating research when the unexpected occurs.

Methods: Health systems research was adapted post crisis to assess health workers’ experiences and coping strategies. Qualitative in-depth interviews were conducted with 14 health workers in a heavily affected earthquake district in Nepal and 25 front line health workers in 4 districts in Ebola-affected Sierra Leone. All data were transcribed and analysed using the framework approach, which included developing coding frameworks for each study, applying the frameworks, developing charts and describing the themes. The second layer of analysis included analysis across the two contexts. The third layer of analysis involved the research teams reflecting on approaches from adapting the research during these crises and what we have learned as individuals and research teams.

Results: In Sierra Leone, health workers were heavily stigmatised by the epidemic leading to a breakdown of trust. Coping strategies included finding renewed purpose in continuing to serve their community, (in some cases) peer and family support, and religion was a strong source of support. In Nepal, individual determination, a sense of responsibility to the community and professional duty compelled staff to stay or return to their workplace. The research teams had trusting relationships with policy makers and practitioners, which brought credibility and legitimacy to the change of research direction as well as the relationships to maximise the opportunity for findings to inform practice.

Conclusions: In both contexts, health workers demonstrated considerable resilience in continuing to provide services despite limited support. Embedded researchers and institutions are arguably best placed to navigate emerging ethical and social justice challenges and are strategically positioned to support the co-production of knowledge and ensure research findings have impact.