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 51-60 of 78 results

  • State fragility and governance: Conflict mitigation and subnational perspectives

    Wiley Online Library, 2011
    Many drivers of intrastate conflict concern the relationship between the state and society, and thus are influenced by the quality of governance. Efforts to restore or create good governance, however, have adopted a relatively standardised democratising template.This article argues that conflict mitigation is a useful mechanism for adapting this template to conditions in fragile states....
  • Health sector recovery in early post-conflict environments: Experience from southern Sudan

    Wiley-Blackwell, 2010
    Health sector recovery in post-conflict settings presents an opportunity for reform: analysis of policy processes can provide useful lessons. The case of southern Sudan is assessed through interviews, a literature review, and by drawing on the experience of former technical advisors to the Ministry of Health....
  • Implementing people-centred health systems governance in 3 provinces and 11 districts of Afghanistan: A case study

    Conflict and health, 2015
    Previous studies show that health systems governance influences health system performance and health outcomes. However, there are few examples of how to implement and monitor good governing practices in fragile and conflict affected environments. Good governance has the potential to make the health system people-centered. More research is needed on implementing a people-centered governance approach in these environments....
  • State-building and human resources for health in fragile and conflict-affected states: exploring the linkages

    Human Resources for Health, 2015
    Human resources for health are self-evidently critical to running a health service and system. There is, however, a wider set of social issues which is more rarely considered. One area which is hinted at in literature, particularly on fragile and conflict-affected states, but rarely examined in detail, is the contribution which health staff may or do play in relation to the wider state-building processes....
  • Availability of essential health services in post-conflict Liberia

    Bulletin of the World Health Organization : the International Journal of Public Health, 2010
    The aim of this paper is to describe the availability of essential health services in rural Liberia five years after the end of the civil war....
  • Social protection and basic services in fragile and conflict-affected situations

    Overseas Development Institute, 2012
    Places affected by fragility and conflict perform consistently worse against a range of development indicators compared to their more stable counterparts. Yet, it is in these contexts that data are most limited, that evidence is of the poorest quality, and that programming and policy making tend to be least informed....
  • Application of social network analysis in the assessment of organizational infrastructure for service delivery: A case study from post-conflict northern Uganda

    Oxford University Press, 2017
    In post-conflict settings, service coverage indices are unlikely to be sustained if health systems are built on weak and unstable inter-organization infrastructures. The objective of this study was to identify and examine the organization-level infrastructure that supports the provision of selected health services in post-conflict northern Uganda....
  • International support to post-conflict transition: Rethinking policy, changing practice

    OECD DAC Guidelines and Reference Series, 2012
    1.5 billion people live in countries affected by repeated cycles of violence and insecurity. These countries face tremendous challenges as they transition from conflict to peace. International support can play a crucial role in these contexts, but has so far struggled to deliver transformative results. This volume presents clear policy recommendations for better practice in order to improve the speed, flexibility, predictability and risk management of international support during post-conflict transition....
  • Promoting health equity in conflict-affected fragile states

    London School of Hygiene and Tropical Medicine, 2007
    This paper was commissioned by the Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health in response to their conclusion that a lack of data from conflict-affected fragile states made it difficult to delineate pragmatic ways of creating better social conditions for health for vulnerable populations.The key questions we focused on were as follows:What are the main factors that threaten health equity and health care equity in conflict and post-conflict fragile states?...
  • Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: A study of policy barriers and opportunities in Cambodia

    Elsevier, 2013
    Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers....

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