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 71-80 of 80 results

  • 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....
  • Have post-conflict development policies addressed horizontal inequalities?

    Department for International Development, UK, 2017
    New research by CRISE reveals important gaps and inconsistencies in post-conflict reconstruction policies on Horizontal Inequalities. Based on in-depth studies of eight diverse post-conflict countries and four cross-cutting thematic studies, the findings provide a framework that helps to explain sources of success, and failure, and points to policy requirements and constraints in this area. In evaluating and explaining the sources of differences in outcomes, this In Brief identifies three key factors that explain success in tackling HIs....
  • 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....
  • Afghanistan's Basic Package of Health Services: Its development and effects on rebuilding the health system

    Taylor and Francis Group, 2014
    In 2001, Afghanistan's Ministry of Public Health inherited a devastated health system and some of the worst health statistics in the world. The health system was rebuilt based on the Basic Package of Health Services (BPHS). This paper examines why the BPHS was needed, how it was developed, its content and the changes resulting from the rebuilding.The methods used for assessing change were to review health outcome and health system indicator changes from 2004 to 2011 structured along World Health Organisation's six building blocks of health system strengthening....
  • A basic package of health services for post-conflict countries: Implications for sexual and reproductive health services

    Taylor and Francis Group, 2008
    Health systems in countries emerging from conflict are often characterised by damaged infrastructure, limited human resources, weak stewardship and a proliferation of non-governmental organisations. This can result in the disrupted and fragmented delivery of health services....
  • A comprehensive framework for human resources for health system development in fragile and post-conflict states

    PLoS Medicine, 2011
    Responding to the global human resource crisis requires systems thinking if a more comprehensive approach to human resource management and development is to be achieved. We present a comprehensive and visible framework for human resource system development. This has been derived from the lessons learned in supporting human resource system development in three fragile and post-conflict health systems in Afghanistan, the Democratic Republic of Congo, and Cambodia....
  • Leaving no one behind: Lessons on rebuilding health systems in conflict- and crisis-affected states

    British Medical Journal, 2017
    Conflict and fragility are increasing in many areas of the world. This context has been referred to as the ‘new normal’ and affects a billion people. Fragile and conflict-affected states have the worst health indicators and the weakest health systems. This presents a major challenge to achieving universal health coverage. The evidence base for strengthening health systems in these contexts is very weak and hampered by limited research capacity, challenges relating to insecurity and apparent low prioritisation of this area of research by funders....
  • Human resource management in post conflict health systems: review of research and knowledge gaps

    BioMed Central, 2014
    In post-conflict settings, severe disruption to health systems invariably leaves populations at high risk of disease and in greater need of health provision than more stable resource-poor countries. The health workforce is often a direct victim of conflict. Effective human resource management (HRM) strategies and policies are critical to addressing the systemic effects of conflict on the health workforce such as flight of human capital, mismatches between skills and service needs, breakdown of pre-service training, and lack of human resource data....
  • When does service delivery improve the legitimacy of a fragile or conflict-affected state?

    Wiley Online Library, 2015
    Received wisdom holds that the provision of vital public services necessarily improves the legitimacy of a fragile or conflict-affected state. In practice, however, the relationship between a state's performance in delivering services and its degree of legitimacy is nonlinear. Specifically, this relationship is conditioned by expectations of what the state should provide, subjective assessments of impartiality and distributive justice, the relational aspects of provision, how easy it is to attribute (credit or blame) performance to the state, and the characteristics of the service....
  • 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....


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