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.

Documents

Leadership/governance

Showing 1-9 of 9 results

  • 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....
  • 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....
  • 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....
  • 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....
  • Effects of a community scorecard on improving the local health system in Eastern Democratic Republic of Congo: Qualitative evidence using the most significant change technique

    Conflict and health, 2017
    More than a decade of conflict has weakened the health system in the Democratic Republic of Congo and decreased its ability to respond to the needs of the population. Community scorecards have been conceived as a way to increase accountability and responsiveness of service providers, but there is limited evidence of their effects, particularly in fragile and conflict-affected contexts. This paper describes the implementation of community scorecards within a community-driven reconstruction project in two provinces of eastern Democratic Republic of Congo....
  • A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002-2012

    Conflict and health, 2014
    Decisions taken in the early recovery period after conflicts may affect the development of health systems. Additionally, some suggest that the immediate post-conflict period may allow for the opening of a political ‘window of opportunity’ for reform. For these reasons, it is useful to reflect on the policy space that exists in this period - what  shapes it, how are decisions made, and what are their long-term implications? Examining the policy trajectory and its determinants can be helpful to explore the specific features of the post-conflict policy-making environment....

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.