Health systems in fragile and conflict-affected states

Healthcare in fragile and conflict-affected settings (FCAS) remains a real challenge, with poor performance on many health-related goals. And with a projected 60% of the world’s extreme poor living in conflict-affected settings by 2030, it is clear that the SDG targets, including on universal health coverage, will not be achieved without a focus on health systems strengthening in FCAS. Yet there is limited evidence available to inform appropriate approaches for governments, development partners, implementing agencies and others seeking to address the particular challenges for health system strengthening in these settings.

The Thematic Working Group on Health Systems in Fragile and Conflict Affected States (TWG-FCAS), part of Health Systems Global, is working for better awareness and dissemination of current and new knowledge on health systems in FCAS, and its translation into policy and practice. This Collection of Resources (below), and linked Key Issue Guides (above), have been collated as part of the Eldis platform, to help those working in these challenging settings to better access relevant published literature and other resources, including relevant organisations, in support of their work.

This Collection will be kept as up to date as possible, and we welcome suggestions for additional relevant resources and other material, including organisations/projects. If you have suggestions for such additional material, please email twgfcascollection@gmail.com with details for consideration by the TWG-FCAS.

For more information and to join the TWG-FCAS, visit our web-page.

This resource has been developed for the TWG-FCAS by the ReBUILD Research Programme, funded by UK Aid from the Department for International Development.

Image credit: Women and children queue at a health clinic in Kapua, Turkana County, northwest Kenya, 29 January 2017 | Russell Watkins/DFID | Flickr | CC BY 2.0

The TWG-FCAS is a working group of researchers, policy-makers, implementers and funders working to support the creation, sharing and use of new knowledge on health systems in fragile and conflict affected settings.

ReBUILD is an international health systems research partnership working to improve access to equitable & effective health care for the poor and vulnerable in conflict and crisis affected settings. ReBUILD is funded by the UK Department for International Development

In this collection

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Showing 41-50 of 78 results

  • An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone

    Elsevier, 2015
    The need for evidence-based practice calls for research focussing not only on the effectiveness of interventions and their translation into policies, but also on implementation processes and the factors influencing them, in particular for complex health system policies....
  • Rehabilitating the health system after conflict in East Timor: A shift from NGO to government leadership

    Oxford University Press, 2006
    Efforts to rehabilitate health systems after periods of prolonged conflict have often been characterized by poor coordination of external actors - multilateral agencies, donors and non-governmental organizations (NGOs). This paper describes the process and analyses the roles of the different stakeholders in the establishment of a government-led district health system in East Timor, between 1999 and 2002, after decades of chronic conflict and Indonesian occupation.Future East Timorese policy-makers and health professionals began to mobilize in May 1999, in preparation for independence....
  • From drought to deluge: How information overload saturated absorption capacity in a disrupted health sector

    Oxford University Press, 2011
    Provision of technical assistance is a common form of support to health sectors emerging from prolonged conflicts. But what actions signal that the Ministry of Health (MoH) is, or is not, actively analysing and digesting the output of this assistance? Where are the boundaries between doing with and doing for?This article presents a qualitative description of an early post-conflict policy process in southern Sudan, which represented an opportunity to test these boundaries. The methodology of provision of technical assistance to the MoH in the formulation of a human resource plan is reviewed....
  • Early recovery: An overview of policy debates and operational challenges

    Overseas Development Institute, 2009
    Informative overview of the key issues to be addressed in early recovery approaches from the Humanitarian Policy Group, based on research with staff from UN agencies, donors and NGOs in headquarters and field offices in Darfur, Gaza, Colombia and Uganda.As they argue, early recovery, stabilisation, peace-building and state-building all offer different frameworks (p.13) that overlap and are often contradictory. They suggest that a more pragmatic approach should be taken to realistically achieve change in the highly political circumstances present in transitional periods....
  • Neglected health systems research: Health policy and systems research in conflict-affected fragile states

    World Health Organization, 2008
    As a result of their extremely poor health indicators, fragile states have recently become prominent on the international health agenda. These countries are furthest from reaching the MDGs, and continue to lag far behind other comparable countries. Whilst they are home to only 20% (or 1 billion) of the world’s population, they contain a third of the world’s poor, a third of the world’s maternal deaths and a third of those living with HIV/AIDS (World Bank, 2007)....
  • Mapping Sierra Leone's plural health system and how people navigate it

    Secure Livelihoods Research Consortium, 2014
    This briefing paper maps the actors that constitute the plural health system in Sierra Leone and the relationships between them. Second, it examines the factors that influence health-seeking behaviour before setting out some recommendations on ways forward when developing appropriate interventions to address malnutrition....
  • From humanitarian and post-conflict assistance to health system strengthening in fragile states: Clarifying the transition and the role of NGOs

    Health Systems 20/20, 2008
    This policy brief focuses on the transition from emergency assistance and relief to strengthening the health system for the long term, and the role of nongovernmental organizations (NGOs) and how they can help fragile states to rehabilitate their health systems. There is general agreement on the broad features of state fragility, but as a category it contains significant variation. Thus, transition strategies and interventions need to be contextualized for particular country situations....
  • Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: A systems dynamics analysis using group model building

    Conflict and health, 2015
    Yobe State has faced severe disruption of its health service as a result of the Boko Haram insurgency. A systems dynamics analysis was conducted to identify key pathways of threat to provision and emerging pathways of response and adaptation.Structured interviews were conducted with 39 stakeholders from three local government areas selected to represent the diversity of conflict experience across the state: Damaturu, Fune and Nguru, and with four officers of the PRRINN-MNCH program providing technical assistance for primary care development in the state....
  • Assessing fiscal space for low-and-middle income countries: A review of the evidence

    World Health Organization, 2016
    Despite the proliferation of the term ‘fiscal space for health’ in recent years, there has been no comprehensive review of how the concept can be applied to assess and support the expansion of resources for the health sector....
  • Health system resilience: Lebanon and the Syrian refugee crisis

    Journal of Global Health, 2016
    Between 2011 and 2013, the Lebanese population increased by 30% due to the influx of Syrian refugees. While a sudden increase of such magnitude represents a shock to the health system, threatening the continuity of service delivery and destabilising governance, it also offers a unique opportunity to study resilience of a health system amidst ongoing crisis.We conceptualised resilience as the capacity of a health system to absorb internal or external shocks (for example prevent or contain disease outbreaks and maintain functional health institutions) while sustaining achievements....

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