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, 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 11-20 of 78 results

  • The Syrian public health and humanitarian crisis: A ‘displacement’ in global governance?

    Taylor and Francis Group, 2018
    Ongoing failure by the international community to resolve the Syrian conflict has led to destruction of critical infrastructure. This includes the collapse of the Syrian health system, leaving millions of internally displaced persons (IDPs) in urgent need of healthcare services. As the conflict intensifies, IDP populations are suffering from infectious and non-communicable disease risks, poor maternal and child health outcomes, trauma, and mental health issues, while healthcare workers continually exit the country....
  • Stakeholder’s perspective: Sustainability of a community health worker program in Afghanistan

    Elsevier, 2017
    The objectives of this study were two-fold: 1) to examine how different stakeholders define sustainability, and 2) to identify barriers to and facilitators of the sustainability of the Afghan CHW program.We interviewed 63 individual key informants, and conducted 11 focus groups [35 people] with policymakers, health managers, community health workers, and community members across Afghanistan. The participants were purposefully selected to provide a wide range of perspectives.Different stakeholders define sustainability differently....
  • Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau

    BioMed Central, 2010
    In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing....
  • Can we halt health workforce deterioration in failed states? Insights from Guinea-Bissau on the nature, persistence and evolution of its HRH crisis

    BioMed Central, 2017
    Guinea-Bissau is one of the world’s poorest and least developed countries....
  • Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia

    BioMed Central, 2017
    Trained community health workers (CHW) enhance access to essential primary health care services in contexts where the health system lacks capacity to adequately deliver them. In Liberia, the Ebola outbreak further disrupted health system function. The objective of this study is to examine the value of a community-based health system in ensuring continued treatment of child illnesses during the outbreak and the role that CHWs had in Ebola prevention activities....
  • The path towards universal health coverage in the Arab uprising countries Tunisia, Egypt, Libya, and Yemen

    Elsevier, 2014
    The constitutions of many countries in the Arab world clearly highlight the role of governments in guaranteeing provision of health care as a right for all citizens. However, citizens still have inequitable health-care systems. One component of such inequity relates to restricted financial access to health-care services. The recent uprisings in the Arab world, commonly referred to as the Arab spring, created a sociopolitical momentum that should be used to achieve universal health coverage (UHC)....
  • 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....
  • 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. One increasingly popular response to improve health service delivery in post-conflict countries is for the country government and international donors to jointly contract non-governmental organisations to provide a Basic Package of Health Services for all the country’s population....
  • 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....


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