Research for stronger health systems during and after crisis

About the ReBUILD Consortium

The ReBUILD Consortium is an international health systems research partnership, funded by the UK Department for International Development, which has addressed the previously neglected area of health systems research in fragile and conflict-affected states (FCAS). From 2011 to early 2019, ReBUILD has produced a large body of original research on issues including health financing design in FCAS, health workforce incentives and organisation post conflict, health systems resilience, gender equitable health systems, and aid effectiveness. The aim has been to support evidence-based policy and practice for improved access of the poor to effective health care and to reduce health costs burdens in settings affected by conflict and crisis. ReBUILD has become a source of leading expertise in this field, establishing rich partnerships with research collaborators, policy makers, international organisations and networks.

ReBUILD is made up of partner organisations in the UK, Sierra Leone, Uganda, Cambodia, Zimbabwe, Timor Leste, with the research focusing on these and a number of other settings which have been affected by political and social conflict.

 

Human resources for health

ReBUILD’s work on human resources for health looked at how the decisions made in the post-conflict period affect the longer-term pattern of attraction, retention, distribution and performance of health workers. Research projects include a large body of work on health worker incentives and health worker deployment systems, with additional projects on the effects of the Ebola outbreak on health workers in Sierra Leone; health workers’ remuneration in Sierra Leone; health worker recruitment and deployment in Timor Leste and community health workers in fragile and conflict-affected settings.

Health financing

ReBUILD’s research on health financing has explored how conflict and post-conflict policies have affected equitable access to healthcare for the most vulnerable households, and the implications of conflict-related demographic change. A significant new body of research has explored performance-based financing in fragile and conflict-affected settings, and further projects have looked at contracting models in Cambodia and universal health coverage with equity in Zimbabwe.

Gender and post-conflict health systems

Gender has been a core theme running through all ReBUILD’s research, and ReBUILD’s pioneering research to explore opportunities and challenges for building gender responsive health systems in post conflict contexts has been developed into the 'Building Back Better' set of resources. ReBUILD has been a core partner in RinGs ‘Research in Gender and Ethics’ – a collaborative research initiative to galvanise gender and ethics analysis in health systems research and strengthening.

Aid effectiveness in the transition from emergency to development aid

This research explored the link between governance and aid effectiveness in strengthening post-conflict health systems in northern Uganda. It has contributed to ReBUILD’s overview materials on health systems ‘institutions’ in conflict and crisis-affected settings, and on health systems in the humanitarian-development interface, as well as specific publications.
See http://bit.ly/Rebuild-Aid.

Health systems resilience

One of ReBUILD’s projects applied a systems dynamics approach to explore factors that influence the resilience of health systems in contexts of adversity. The concept was further explored to produce an overview brief on resilience of health systems during and after crisis and a collaborative short briefing note on health systems resilience addressing key questions for donors.

Additional research

Further projects from ReBUILD’s partners have explored psychosocial support and service provision for adolescent girls in post-conflict settings, building on the Overseas Development Institute's wider work on this theme, and used appreciative inquiry to explore what works in Cambodia’s obstetric referral system.

 

Key questions for health systems in conflict and crisis-affected settings - what do we know?

As well as its original research, ReBUILD has produced a number of synthesis briefing papers drawing on wider research, to inform specific health systems challenges in conflict and crisis-affected settings.

Research into policy and practice

Ensuring that the knowledge that the research generates is useful to decision makers and practitioners has been crucial to this work. ReBUILD's partners have been actively working throughout the programme with a wide array of stakeholders from government, academia, donor organisations, professional bodies and civil society to ensure that the research contributes to real change that makes a significant impact for the lives of the world's most vulnerable populations.

 

See ReBUILD's Barbara McPake talking about ReBUILD's work and its contribution to the building of resilient and responsive health systems in states recovering from conflict.