Sarah Ssali is a senior lecturer in Women and Gender Studies at Makere University, Uganda. She is also a member of the ReBUILD consortium.

In this HEART talks video she notes the problem in thinking that reconstructing health systems in fragile contexts is just about reconstructing the buildings. This is important because of the deconstruction that comes with war but it is also important that people are able to access and use those services. Post-war women are often widowed and have low access to livelihood options. Healthcare markets that arose after conflict in northern Uganda mean that many women cannot access healthcare services. Many widows also have dependents. It is important to conduct a gender analysis in post-conflict reconstruction to make sure that everyone, particularly women and children who are most likely to be negatively affected by the conflict, can access health services.

To understand the gender dynamics of post-conflict health reconstruction, particular effort must be made to find out about the lived experiences of women. This means engaging in research methods to find out people’s stories and situations. To engage with women who are less literate Sarah Ssali used life history interviewing, an in-depth strategy which focusses on narrative. Significant life events and significant health events were then mapped. This identified people’s engagement with health systems before, during and after the war. One finding was that before the war access to health services was low but people were able to find funding for health needs by selling animals when needed. During the war access was slightly better. After the war, accessing services was a challenge. Life history interviewing gave women voice and some empowerment. There narratives were preserved in the way they wanted it. The technique allowed linking between intervention, the persons engagement with the healthcare system and the social/gender/power relations that they are located in.

For more on gender and post-conflict health systems see other HEART talks in this series:

• Valerie Percival on the importance of understanding gender equity in humanitarian responses to health issues
• Haja Wurie on incorporating gender into health systems reconstruction in post-Ebola Sierra Leone
• Rosemary Morgan on gender in health systems research
• Group interview with Sarah Ssali, Sally Theobald, Rosemary Morgan and Asha George on essential gender issues in relation to health systems.