Research for stronger health systems during and after crisis

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The ReBUILD programme - overview

The ReBUILD Research Programme

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

Why is this work important?

About 25% of the world’s population lives in fragile and conflict-affected settings, but the proportion of the world’s poor living in these settings is much larger than this, and is growing – projected to reach over 60% by 2030[1]. Addressing health needs in these settings is critically important: for example 60% of the world’s maternal deaths[2] and 60% of the world’s children who die before the age of 5[3] live in fragile settings. And health systems are severely affected by conflict, which disrupts the balance and relationships between the supply of health care services and their ability to meet the health needs and demands of the population.

Against this background, demand for ReBUILD's work is high, and the team is keen to continue to share the knowledge and insights it has gained so that others might learn from and act on the findings of this programme. This page gives an overview of ReBUILD’s research projects with links to relevant outputs and further information. It can be downloaded as a pdf version.

[1] OECD (2015) States of Fragility 2015 – Meeting post-2015 ambitions, OECD Publishing, Paris. [2] UNFPA (2015) Maternal mortality in humanitarian crises and in fragile settings. Statistics brief, UNFPA. [3] OECD (2018), States of Fragility 2018 OECD Publishing, Paris

ReBUILD’s research and outputs:

ReBUILD’s research from 2011 to 2016 predominantly focused on the post-conflict settings of Cambodia, Sierra Leone, Uganda and Zimbabwe, working with national partners in these countries. The thematic and geographical scope of this work has been complemented both through affiliate partners’ research and by further core research from 2017 to 2019, to include Timor Leste, the Democratic Republic of Congo, Sri Lanka, Liberia, Gaza, Côte d’Ivoire, Nigeria, South Africa and Central African Republic.

The research projects under the different themes are listed below, with links to resource lists. As well as its original research, ReBUILD has produced synthesis outputs drawing on wider research[1], to inform specific health systems challenges in conflict and crisis-affected settings.

[1] See [Bit.ly link for https://rebuildconsortium.com/resources/briefs/health-systems-during-and-after-crisis-evidence-for-better-policy-and-practice/

Human resources for health

ReBUILD’s work on human resources for health has 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, and thus ultimately the performance of the sector. 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.

Research outputs on human resources for health:

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, as well as 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 in Zimbabwe.[1]

Research outputs on health financing:

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' '[1] set of resources to help better address gender in these contexts. ReBUILD has been a core partner in the RinGs “Research in Gender and Ethics” initiative – a collaborative research initiative to galvanise gender and ethics analysis in health systems research and strengthening[2].

 

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.

 

Health systems resilience:

One of ReBUILD’s affiliate projects applied a systems dynamics approach to explore factors that influence the resilience of health systems in contexts of adversity. ReBUILD has further explored the concept of resilience 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 affiliate 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.

 

Synthesis and cross-cutting outputs:

ReBUILD has produced a number of cross-cutting synthesis outputs on health systems in conflict and crisis affected settings, including two series of briefing papers.

A set of 4 briefs synthesises ReBUILD’s research up to 2016, with findings and recommendations around three core ‘themes’ of health workers, communities and health financing, and health systems institutions after conflict and crisis. These are also available as French translations.

  1. The ReBUILD programme and overview of emerging themes
  2. Health financing policy in conflict affected settings
  3. Establishing a responsive and equitable health workforce post-conflict
  4. Institutions for strong and equitable health systems after conflict and crisis

A second set of 11 briefs, Health systems during and after crisis: evidence for better policy and practice, draw both on ReBUILD’s and wider research to address a number of key questions around health systems in conflict and crisis affected settings[4], and are also available as French translations.

  1. Resilience of health systems during & after crisis
  2. Inclusive health systems in crisis-affected settings
  3. Universal health coverage in crisis-affected settings
  4. Types of health system provider during & after crisis
  5. Political economy of crisis-affected health systems
  6. State-building & health systems during & after crisis
  7. Sustainability of health systems during & after crisis
  8. Health systems research capacity in crisis-affected settings
  9. Responding to humanitarian crises in ways that contribute to stronger health systems
  10. Performance-based financing in fragile and conflict-affected settings

[4] These priority research questions were identified in a research needs and challenges study carried out by the Health Systems Global Thematic Working Group on Health Systems in Fragile and Conflict Affected States