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 31-40 of 75 results

  • Removing user fees in the health sector: A review of policy processes in six sub-Saharan African countries

    Oxford University Press, 2011
    In recent years, governments of several low-income countries have taken decisive action by removing fully or partially user fees in the health sector. In this study, we review recent reforms in six sub-Saharan African countries: Burkina Faso, Burundi, Ghana, Liberia, Senegal and Uganda.The review describes the processes and strategies through which user fee removal reforms have been implemented and tries to assess them by referring to a good practice hypotheses framework....
  • Complex emergencies and the crisis of developmentalism

    Institute of Development Studies UK, 1994
    This article takes complex emergencies and the humanitarian response to them as its point of reference. It provides critique of relief, development and the linking debate. Rather than being autonomous, relief is a developmental idea. However, development concepts have proven incapable of explaining permanent emergency. They also underestimate the extent of the North's institutional accommodation with unresolved political crisis in the South.Beginning with non-mandated NGO operations, there has been a growing acknowledgement of the inevitability of working in conflict situations....
  • 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....
  • Ebola in the context of conflict affected states and health systems: Case studies of Northern Uganda and Sierra Leone

    BMC Health Research Policy and Systems, 2015
    Ebola seems to be a particular risk in conflict affected contexts. All three of the countries most affected by the 2014-15 outbreak have a complex conflict-affected recent history. Other major outbreaks in the recent past, in Northern Uganda and in the Democratic Republic of Congo are similarly afflicted although outbreaks have also occurred in stable settings....
  • Health systems research in fragile and conflict affected states: A qualitative study of associated challenges

    BMC Health Research Policy and Systems, 2017
    High quality health systems research (HSR) in fragile and conflict-affected states (FCAS) is essential to guiding the policies and programmes that will improve access to health services and, ultimately, health outcomes. Yet, conducting HSR in FCAS is challenging. An understanding of these challenges is essential to tackling them and to supporting research conducted in these complex environments. Led by the Thematic Working Group on Health Systems in FCAS, the primary aim of this study was to develop a research agenda on HSR in FCAS....
  • A Congolese community-based health program for survivors of sexual violence

    BioMed Central, 2012
    Many survivors of gender based violence (GBV) in the Democratic Republic of Congo (DRC) report barriers to access health services including, distance, cost, lack of trained providers and fear of stigma. In 2004, Foundation RamaLevina (FORAL), a Congolese health and social non-governmental organization, started a mobile health program for vulnerable women and men to address the barriers to access identified by GBV survivors and their families in rural South Kivu province, Eastern DRC....
  • Governance and capacity to manage resilience of health systems: Towards a new conceptual framework

    Kerman University of Medical Sciences, 2017
    The term resilience has dominated the discourse among health systems researchers since 2014 and the onset of the Ebola outbreak in West Africa. There is wide consensus that the global community has to help build more resilient health systems. But do we really know what resilience means, and do we all have the same vision of resilience? The present paper presents a new conceptual framework on governance of resilience based on systems thinking and complexity theories....
  • 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....

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