Health systems in fragile and conflict-affected states

Healthcare in fragile and conflict-affected states (FCAS) remains a real challenge, with poor performance on many health-related goals. But little evidence exists on appropriate approaches for health systems strengthening in such settings. The Thematic Working Group on Health Systems in Fragile and Conflict Affected States (TWG-FCAS), part of Health Systems Global.

One of the key objectives of the TWG-FCAS is to support the awareness and dissemination of current and new knowledge, and to support its translation into policy and practice. This collection of resources on the Eldis platform and associated Key Issue Guides are supporting these objectives.

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.


Showing 21-30 of 40 results

  • 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....
  • The war wounded and recovery in northern Uganda

    Secure Livelihoods Research Consortium, 2014
    In 2012/13, SLRC implemented the first round of an original sub-regional panel survey in northern Uganda aimed to produce data on livelihoods, access to and experience of basic services, exposure to shocks and coping strategies, people’s perceptions of governance, and the impact of serious crimes committed during the Government of Uganda and Lord’s Resistance Army conflict on households’ livelihoods, access to services, exposure to crimes, and perceptions of governance....
  • Perceptions and experiences of access to public healthcare by people with disabilities and older people in Uganda

    BioMed Central, 2014
    In the year 2000, a set of eight Millennium Development Goals (MDGs) were presented as a way to channel global efforts into the reduction of poverty and the promotion of social development. A global discussion regarding how to renew these goals is underway and it is in this context that the Goals and Governance for Global Health (Go4Health) research consortium conducted consultations with marginalized communities in Asia, Latin America, the Pacific and Africa as a way to include their voices in world’s new development agenda....
  • Health systems and gender in post-conflict contexts: Building back better?

    BioMed Central, 2014
    The post-conflict or post-crisis period provides the opportunity for wide-ranging public sector reforms: donors fund rebuilding and reform efforts, social norms are in a state of flux, and the political climate may be conducive to change. This reform period presents favourable circumstances for the promotion of gender equity in multiple social arenas, including the health system....
  • Community health workers of Afghanistan: A qualitative study of a national program

    BioMed Central, 2014
    Afghanistan is a country that has been in conflict for decades, resulting in the destruction of much of its social infrastructure including the health system. In 2003, after the intervention of US-led NATO forces, the new government with support from its international partners designed a Basic Package of Health Services to provide services to the majority rural population; its specific focus is on women and children. The workforce to deliver these services consists of Community Health Workers (CHWs)....
  • Living through conflict and post-conflict: Experiences of health workers in northern Uganda and lessons for people-centred health systems

    Health Policy and Planning, 2014
    Providing people-centred health systems—or any systems at all—requires specific measures to protect and retain healthcare workers during and after the conflict. This is particularly important when health staff are themselves the target of violence and abduction, as is often the case. This article presents the perspective of health workers who lived through conflict in four districts of northern Uganda—Pader, Gulu, Amuru, and Kitgum. These contained more than 90% of the people displaced by the decades of conflict, which ended in 2006....
  • Evolution of policies on human resources for health: Opportunities and constraints in four post-conflict and post-crisis settings

    BioMed Central, 2017
    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. This article uses a comparative policy analysis framework....
  • Impact of health financing policies in Cambodia: A 20 year experience

    Elsevier, 2017
    Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups....
  • Supporting statebuilding in situations of conflict and fragility: Policy guidance

    OECD DAC Guidelines and Reference Series, 2011
    Functioning states are essential for reducing poverty, sustaining peace and achieving agreed development goals. Despite receiving growing international attention in recent years, fragile states are falling behind other low-income countries in human development. Fragility – and its negative consequences – can destabilise entire regions and have global repercussions. Tackling the challenges associated with fragility requires a concerted international effort to support sustainable statebuilding processes, based on robust state-society relations....


The TWG-FCAS is a working group of Health Systems Global, bringing together researchers, policy-makers, funders and implementers working in fragile and conflict affected states (FCAS), to promote and support the creation, identification and sharing of knowledge, and the translation of this knowledge into policy and practice.