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, with the addition of any new, relevant resources and other material sent to the TWG-FCAS. If you have suggestions for such additional material, please email twgfcascollection@gmail.com. [or linked email account – need to check this]

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.

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 21-30 of 75 results

  • Targeting accuracy and impact of a community identified waiver card scheme for primary care user fees in Afghanistan.

    BioMed Central, 2010
    User fees are a known common barrier to using health services, particularly among the poor. When fees are present, many facilities have waiver systems for poor patients to exempt them from paying. Targeting waivers to patients who need them most has been a challenge, especially in fragile states, where relevant data are limited and trust in institutions is low. Community-based targeting of vulnerable households was piloted in Afghanistan and evaluated for its feasibility, accuracy and effect on care-seeking....
  • Terrorist attack of 15 January 2016 in Ouagadougou: how resilient was Burkina Faso's health system?

    BMJ Publishing Group, 2016
    In Africa, health systems are often not very responsive. Their resilience is often tested by health or geopolitical crises. The Ebola epidemic, for instance, exposed the fragility of health systems, and recent terrorist attacks have required countries to respond to urgent situations. Up until 2014, Burkina Faso's health system strongly resisted these pressures and reforms had always been minor. However, since late 2014, Burkina Faso has had to contend with several unprecedented crises. In October 2014, there was a popular insurrection....
  • Human resources for health through conflict and recovery: lessons from African countries

    Wiley Online Library, 2011
    A protracted conflict affects human resources for health (HRH) in multiple ways. In most cases, the inflicted damage constitutes the main obstacle to health sector recovery. Interventions aimed at healing derelict human resources are however fraught with difficulties of a political, technical, financial and administrative order. The experience accumulated in past recovery processes has made some important players aware of the cost incurred by neglecting human resource development. Several transitions from conflict to peace have been documented, even if largely in unpublished reports....
  • Rebuilding and strengthening health systems and providing basic health services in fragile states

    Wiley Online Library, 2011
    The international community has compelling humanitarian, political, security and economic reasons to engage in rebuilding and strengthening health systems in fragile states. Improvements in health services and systems help to strengthen civil society and to restore legitimacy to governments. Effective engagement with fragile states to inform the design of health programmes and selection of interventions depends on donor coordination and an understanding of health system challenges....
  • Contracting out health services in fragile states

    BMJ Publishing Group, 2006
    Many Western health systems contract out healthcare services, including the NHS. Contracts are less common in low income countries, but contracts with non-governmental organisations (NGOs) to deliver health services are increasingly being promoted in so called fragile states—countries affected by conflict, emerging from conflict, or otherwise lacking the will or capacity to implement pro-poor policies. Contracts with NGOs are seen as an effective way to expand services quickly....
  • Exploring pathways for building trust in vaccination and strengthening health system resilience

    BioMed Central, 2016
    Trust is critical to generate and maintain demand for vaccines in low and middle income countries. However, there is little documentation on how health system insufficiencies affect trust in vaccination and the process of re-building trust once it has been compromised. We reflect on how disruptions to immunizations systems can affect trust in vaccination and can compromise vaccine utilization....
  • Barriers to appropriate care for mothers and infants during the perinatal period in rural Afghanistan: a qualitative assessment

    Taylor and Francis Group, 2014
    This study, conducted in five rural districts in Afghanistan, used qualitative methods to explore traditional practices of women, families and communities related to maternal and newborn care, and sociocultural and health system issues that create access barriers. The traditional practices discussed include delayed bathing of mothers and delayed breastfeeding of infants, seclusion of women after childbirth, restricted maternal diet, and use of traditional home remedies and self-medication instead of care in health facilities to treat maternal and newborn conditions....
  • Health workers experiences of and movement between public and private not-for-profit sectors - findings from post-conflict Northern Uganda

    BioMed Central, 2016
    Northern Uganda suffered 20 years of conflict which devastated lives and the health system. Since 2006, there has been investment in reconstruction, which includes efforts to rebuild the health workforce....
  • Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems

    Oxford University Press, 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....
  • Health worker experiences of and movement between public and private not-for-profit sectors

    BioMed Central, 2016
    Northern Uganda suffered 20 years of conflict which devastated lives and the health system. Since 2006, there has been investment in reconstruction, which includes efforts to rebuild the health workforce....

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