Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states

Abstract

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. This article reports on findings from a multicountry consortium examining health systems rebuilding post conflict/crisis in Sierra Leone, Zimbabwe, northern Uganda and Cambodia. Across the ReBUILD consortium's interdisciplinary research programme, three cross-cutting themes have emerged through our analytic process: communities, human resources for health and institutions. Understanding the impact of conflict/crisis on the intersecting inequalities faced by households and communities is essential for developing responsive health policies. Health workers demonstrate resilience in conflict/crisis, yet need to be supported post conflict/crisis with appropriate policies related to deployment and incentives that ensure a fair balance across sectors and geographical distribution. Postconflict/crisis contexts are characterised by an influx of multiple players and efforts to support coordination and build strong responsive national and local institutions are critical. The ReBUILD evidence base is starting to fill important knowledge gaps, but further research is needed to support policy makers and practitioners to develop sustainable health systems, without which disadvantaged communities in postconflict and postcrisis contexts will be left behind in efforts to promote universal health coverage.

Strengthening Health Systems in Humanitarian Settings: Multi-Stakeholder Insights on Contraception and Postabortion Care Programs in the Democratic Republic of Congo and Somalia

“…This was accomplished by positively in uencing national policies and guidance, strengthening local coordination mechanisms, capacitating the healthcare workforce with competency-based training, mentoring, on-the-job training, and supportive supervision (bene ting facilities supported by the project and beyond), developing the capacity of project and MoH staff in the effective management of the supply chain, actively and creatively mobilizing the community to raise awareness and create demand, and providing quality and affordable services. Contributions of this package to increased utilization of services and long-acting contraceptives were quantitatively evidenced in previous publications[12][13][14].Save the Children's strategic and programmatic investments align with the results of a study published in 2017 by Martineau et al who analyzed research evidence on rebuilding health systems in con ict-and crisis-affected countries[25]. According to the analysis, the starting points for policy development and systems strengthening are the community, human resources for health, and institutions.With regard to institutions, the arrival of multiple actors and resulting power dynamics requires strong coordination to optimize the capacity building and response of national and local institutions[26].…”

Health-related publications on fragile states in the alert zone: a bibliometric analysis

“…The current study will serve (1) research and health institutions interested in global health security to better assess research on fragile states [14]; (2) international health agencies to allocate research gaps in these fragile states and tailor health support and health aids based on the identified gaps; (3) international funding agencies to strengthen health systems in most neglected health aspects [15,16]; and (4) create and encourage research collaboration with colleagues in fragile states to rebuild the health research capabilities [17].…”

What does ‘leave no one behind’ mean for humanitarian crises-affected populations in the COVID-19 pandemic?

“…Health systems in humanitarian settings are often poorly resourced and suffer from workforce shortages. 4 Controlling COVID-19 requires multidisciplinary input from doctors to cleaners, whose integral role in prevention of spread of disease is often disregarded. 5 A 2015 survey on infection prevention and control (IPC) preparedness of institutions worldwide showed that preparedness levels were only partially adequate.…”