Reproductive, maternal, newborn and child health service delivery during conflict in Yemen: a case study

Abstract

Background: Armed conflict, food insecurity, epidemic cholera, economic decline and deterioration of essential public services present overwhelming challenges to population health and well-being in Yemen. Although the majority of the population is in need of humanitarian assistance and civil servants in many areas have not received salaries since 2016, many healthcare providers continue to work, and families continue to need and seek care.Methods: This case study examines how reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH+N) services have been delivered since 2015, and identifies factors influencing implementation of these services in three governorates of Yemen. Content analysis methods were used to analyze publicly available documents and datasets published since 2000 as well as 94 semi-structured individual and group interviews conducted with government officials, humanitarian agency staff and facility-based healthcare providers and six focus group discussions conducted with community health midwives and volunteers in September-October 2018.Results: Humanitarian response efforts focus on maintaining basic services at functioning facilities, and deploying mobile clinics, outreach teams and community health volunteer networks to address urgent needs where access is possible. Attention to specific aspects of RMNCAH+N varies slightly by location, with differences driven by priorities of government authorities, levels of violence, humanitarian access and availability of qualified human resources. Health services for women and children are generally considered to be a priority; however, cholera control and treatment of acute malnutrition are given precedence over other services along the continuum of care. Although health workers display notable resilience working in difficult conditions, challenges resulting from insecurity, limited functionality of health facilities, and challenges in importation and distribution of supplies limit the availability and quality of services.

Providing care under extreme adversity: The impact of the Yemen conflict on the personal and professional lives of health workers

“…The study, guided by a common protocol for case studies conducted by the BRANCH (Bridging Research & Action in Conflict Settings for the Health of Women and Children) Consortium in multiple conflict-affected countries, included a review of documents and datasets reporting RMNCAH + N service coverage and implementation strategies since 2000 and primary data collection in three governorates of Yemen in late 2018 ( Ataullahjan, 2020 ). Broader case study findings are published elsewhere ( Tappis, 2020 #2).…”

“…This is a qualitative study, drawing on primary data collection conducted as part of a case study examining how reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH + N) services have been delivered in Yemen since the start of the crisis in 2015 ( Tappis, 2020 ). The study, guided by a common protocol for case studies conducted by the BRANCH (Bridging Research & Action in Conflict Settings for the Health of Women and Children) Consortium in multiple conflict-affected countries, included a review of documents and datasets reporting RMNCAH + N service coverage and implementation strategies since 2000 and primary data collection in three governorates of Yemen in late 2018 ( Ataullahjan, 2020 ).…”

Researching the delivery of health and nutrition interventions for women and children in the context of armed conflict: lessons on research challenges and strategies from BRANCH Consortium case studies of Somalia, Mali, Pakistan and Afghanistan

“…Detailed reports of the BRANCH case studies [13][14][15][16][17][18][19][20][21][22] as well as a cross-case synthesis of findings [23] are published elsewhere. For this additional paper, we aimed to highlight and discuss some of the research challenges faced and the corresponding mitigation strategies used by the international research teams conducting BRANCH case studies in Somalia, Mali, Pakistan and Afghanistan ( Table 1).…”

Mitigating toxic stress in children affected by conflict and displacement

“…41 As epidemics or pandemics such as covid-19 further constrain resources and health worker capacity, task shifting to community health workers can allow access to hard-to-reach populations in countries such as Somalia 42 and Yemen. 43 Community based interventions are important in the short and long term rehabilitation of children experiencing toxic stress. 36 School based programs can help overcome some of the barriers to access to care and improve educational outcomes.…”

“…These models often leverage the strengths inherent in collectivist cultures in war affected regions 41. As epidemics or pandemics such as covid-19 further constrain resources and health worker capacity, task shifting to community health workers can allow access to hard-to-reach populations in countries such as Somalia42 and Yemen 43…”