Research for stronger health systems during and after crisis

Global literature review of health financing in post conflict states

Saturday, 01 Sep 2012

ReBUILD aims to reduce poverty in post conflict countries via improved access of the poor to effective health care. It is therefore fitting that we focus on health financing; we are looking at the effects of the health financing policy on the budgets of the poorest households. 

ReBUILD Researcher, Sophie Witter (pictured right), reflects on the findings following a global literature review of health financing in post-conflict states:

There is some level of ambiguity in the definition of a post-conflict country.  How long after conflict is a country still ‘post-conflict’, for example? For ReBUILD, Cambodia and Sierra Leone were in conflict some time ago, whereas Northern Uganda’s conflict and Zimbabwe’s political crisis were more recent. This range presents an opportunity to study the path which countries have taken in coming out of conflict. While the post-conflict trajectory is important to understanding and tracking their current health sector developments, it is also important to see each as a unique case study. 

Are the challenges which they face qualitatively different from those faced by fragile states and low-income states more generally? Post-conflict states seem to present similar challenges to resource-constrained environments, but to a greater extent, and often in a more divided political setting.

Much of the literature on health financing is focussed on aid strategies – tracking aid, aid delivery vehicles and harmonisation (or lack of it), and debates around the transition from humanitarian to development aid. While post-conflict states may be particularly aid-dependent, it seems that there should be a wider research agenda, looking at what the conflict legacy may be, and how it can be managed. 

There is very limited discussion, for example, of different health financing options in fragile contexts, such as community health financing and the utility of demand side financing approaches. Little has been published on the distribution or fairness of access to health services in post-conflict settings, including household payments, affordability and use of services. It may be assumed that equity improves; post-conflict, for example, but withdrawal of humanitarian aid and the return of charging may in fact reduce access. These are patterns that we will analyse in ReBUILD. 

Post-conflict states present something of a paradox – they have severe capacity constraints, in most cases, while also offering opportunities for change and reconfiguration. 

This is why most of the ReBUILD research projects take a historical perspective, following policy changes before, during and after conflict. We are interested to see not just how health systems are affected by and respond to conflict, but also how those responses are modified over time and affect the longer term sector development. Out of this will be lessons for pro-poor policies, not just for post-conflict but also wider low income and fragile states contexts.