Health systems in fragile and conflict-affected settings

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 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


Showing 21-30 of 80 results

  • Do health systems contribute to reduced fragility and state-building during and after crises?

    ReBUILD Consortium, 2017
    The process of ‘state-building’ after periods of crisis has attracted significant recent attention in humanitarian and development sectors. Health systems are an important outcome of state-building, but are also argued by some to be a driver of the state-building process itself. Access to health services is valued across ideologies and offers a way of encouraging reconciliation and preventing future crises,1 a logic sometimes referred to as ‘health as a bridge to peace’.2 This brief discusses the associations between health systems and state-building and the empirical evidence in this area...
  • 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....
  • State-building and human resources for health in fragile and conflict-affected states: exploring the linkages

    BioMed Central, 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....
  • Implementing a basic package of health services in post-conflict Liberia: perceptions of key stakeholders

    Elsevier, 2013
    Recovery of the health sector in post-conflict countries is increasingly initiated through a Basic Package of Health Services (BPHS) approach. The country government and partners, including international donors, typically contract international and local NGOs to deliver the BPHS. Evidence from routine data suggests that a BPHS approach results in rapid increases in service coverage, coordination, equity, and efficiency. However, studies also show progress may then slow down, the cause of which is not immediately obvious from routine data....
  • Rebuilding human resources for health: a case study for Liberia

    BioMed Central, 2011
    Following twenty years of economic and social growth, Liberia's fourteen-year civil war destroyed its health system, with most of the health workforce leaving the country. Following the inauguration of the Sirleaf administration in 2006, the Ministry of Health & Social Welfare (MOHSW) has focused on rebuilding, with an emphasis on increasing the size and capacity of its human resources for health (HRH). Given resource constraints and the high maternal and neonatal mortality rates, MOHSW concentrated on its largest cadre of health workers: nurses....
  • 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....


See all content in Eldis on Health systems in fragile and conflict affected settings