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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. [ABSTRACT FROM AUTHOR]

Objectives: Many countries face challenges in terms of number, skill mix, quality and distribution of the health workforce. This paper provides an overview of interventions focusing on retention adopted over the last decade in seven countries of francophone Africa. We assessed these interventions with respect to WHO guidelines and evaluated the extent of application of these recommended policies., Methods: This study was conducted according to a comparative multiple case-study design and comprised two phases. First, seven country reports were consulted to provide a mapping and preliminary analysis of the interventions. Secondly, an analytic synthesis was prepared by systematically and deliberately comparing and contrasting country cases in order to draw higher-level conclusions., Results: This comparative analysis indicated that some WHO guidelines are introduced less often than others and HRH retention policies are rarely envisaged within coherent ?bundles' of interventions. This analysis identifies the efforts to develop local (informal) strategies tailored to the context, while official policy-making often remains a standardized exercise, which does not take context-specific features into account. Moreover, little information is available on the implementation and effectiveness of existing policies., Discussion and Conclusions: The study stresses the importance of two key issues for the design of effective policies: the availability of sound data, as well as monitoring and evaluation structures, and the creation of a supportive and coherent political environment, focused on country-driven, realistic policy-making based on contextual problem identification and actual needs. This paper also suggests that good practices are often the result of local adaptations, rather than the close adoption of standardized guidelines. Therefore, in order to be effective, international guidelines must be complemented by locally acquired and fully appropriated knowledge.