health systems in post-conflict states - learning from the rebuild programme
TRANSCRIPT
Health systems in post-conflict states Learning from the ReBUILD programme
Joanna RavenLiverpool School of Tropical Medicine
Workshop on Rebuilding Health in Yemen after Conflict
4th June 2016, Liverpool
Research for stronger health systems post conflict
Background on ReBUILD
Post conflict is a neglected
area of health system
research
Opportunity to set health systems in a
pro-poor direction
Useful to think about what policy space
there is in the immediate
post-conflict period
Choice of focal
countries enable
distance and close up view
of post conflict
Decisions made early post-conflict can steer the long term development of the health system
Research for stronger health systems post conflict
ReBUILD’s research and partnership• Countries:
• Sierra Leone• Cambodia• Northern Uganda• Zimbabwe• plus several ‘affiliate’ projects in other
countries
• Partners:• In all cases, working with national partners
• UK partners: • Liverpool School of Tropical Medicine• Queen Margaret University, Edinburgh
Health financing
Gender &equity
Health workforce
Aid architecture
Contractingmodels
ReBUILD’sresearch
Research for stronger health systems post conflict
Health Needs of population
(demand)
Health services
(supply)
Conflict and crisis creates change
How
can
dec
ision
s mad
e ea
rly p
ost-c
onfli
ct o
r cr
isis s
teer
the
long
term
dev
elop
men
t of t
he
heal
th sy
stem
?
Thematicareas
Actors & networks
Policy and power
Vulnerability
Household structure
Accessing healthcare
Resource flows
Attraction/retention
Posting
Policy making
Effects and responses
Institutions
Health workers
Communities
Stro
nger
hea
lth s
yste
ms p
ost c
onfli
ct a
nd c
risis
Research question
Enha
nced
vul
nera
bilit
yGender
Institutions• Post-conflict brings networks of diverse actors
• Different priorities; fragmented approaches • Can overwhelm national/local capacity• State actors role must be kept strong
• Resource flows controlled by external actors:• ‘Vertical programmes’ v ‘systems’ • Resources must follow need• Need national coordination/scrutiny
• Policy & power:• Policy often externally driven. • Lack of local ownership; weak implementation. • External actors powerful at local level
Gulu District
HIV Treatment Service Networks; Gulu, northern Uganda
Institutions• Post-conflict brings networks of diverse actors
• Different priorities; fragmented approaches • Can overwhelm national/local capacity• State actors role must be kept strong
• Resource flows controlled by external actors:• ‘Vertical programmes’ v ‘systems’ • Resources must follow need• Need national coordination/scrutiny
• Policy & power:• Policy often externally driven. • Lack of local ownership; weak implementation. • External actors powerful at local level
Gulu District
HIV Treatment Service Networks; Gulu, northern Uganda
Service delivery
Relevant building blocks
Financing
Governance
Health workers • Attraction and retention in underserved areas
• Local staff & mid-level cadres more likely to work in remote areas
• To work in remote areas workers need: • recognition of role and achievements in challenging
circumstances• practical measures to improve their security• provision of decent housing, working conditions and
pay• trust, communication and teamwork
• Posting• Take workers’ preferences in terms of job location
increases retention• Policy making
• Local actors need to lead health worker policy process• Gender
• Gender needs to be integrated in all new health worker regulations and policies
Health workers • Attraction and retention in underserved areas
• Local staff & mid-level cadres more likely to work in remote areas
• To work in remote areas workers need: • recognition of role and achievements in challenging
circumstances• practical measures to improve their security• provision of decent housing, working conditions and
pay• trust, communication and teamwork
• Posting• Take workers’ preferences in terms of job location
increases retention• Policy making
• Local actors need to lead health worker policy process• Gender
• Gender needs to be integrated in all new health worker regulations and policies
Relevant building blocks
Human resources
Communities • Household structure • Increased proportion of female headed households • Conscription, impact of conflict and the missing
generation of children
• Vulnerability and resilience • Increasing numbers of people with disability• Female headed households - disadvantaged or
resilient?
• Accessing healthcare • Draw on resources from households, extended
family, gifts and small loans from communities
Communities • Household structure • Increased proportion of female headed households • Conscription, impact of conflict and the missing
generation of children
• Vulnerability and resilience • Increasing numbers of people with disability• Female headed households - disadvantaged or
resilient?
• Accessing healthcare • Draw on resources from households, extended
family, gifts and small loans from communities
Financing
Service delivery
Relevant building blocks
More information, resources & networks• ReBUILD Consortium website – www.rebuildconsortium.com• All ReBUILD resources, updates and further information
• HSG Thematic Working Group on Health Systems in Fragile and Conflict Affected States• A wider network of actors interested in health systems research and
strengthening in fragile and conflict-affected settings
• Building Back Better• Resources and case studies on gender and post-conflict health systems
BUILDING BACK BETTERA NEW E-RESOURCE:
WWW.BUILDINGBACKBETTER.ORG
Research for stronger health systems post conflict
Website:www.rebuildconsortium.com
Contact:[email protected]
@ReBUILDRPC
Thank you