Research for stronger health systems during and after crisis

GenDis - Demographic and distributional impacts of conflicts and implications for health systems

Lead: Prof Barbara McPake

Purpose of the research

This project aims to understand the implications of conflict-related demographic change for health financing and social protection policies intended to ensure access to healthcare without impoverishing effects. 

The study is reanalysing new and existing quantitative data sets from Cambodia, Sierra Leone and Uganda, aiming to identify changes in household structures that respond to demographic change, and associations with poverty, access to health care and health expenditures. We are also carrying out complementary qualitative research in each country to gain a more thorough understanding of the nature and impact of conflict-related missing generations and gender imbalances. An analysis of health financing and social protection policies is being carried out to review how they respond to the kind of problems identified in the qualitative and quantitative components of the study.


Countries and policy context

We are working in Cambodia, Uganda and Sierra Leone, where initial ReBUILD work was carried out on access to health services during and after conflict.  Each country has established mechanisms aimed at protecting poor households from impoverishing health expenditures (most notably free public health care in Uganda, targeted free public health care in Sierra Leone and health equity funds in Cambodia). Cambodia and Uganda are also expanding social protection more broadly, with the introduction of a targeted and limited pension system being piloted in Northern Uganda and a disability compensation scheme in Cambodia .


Expected areas of influence

It is expected that through liaison with key personnel in Ministries of Health in all three countries, as well as other actors, the findings of this study will support the modification of health financing and social protection policy and mechanisms, and better assure conflict-affected households’ access to health care. The findings will also provide an opportunity to review the targeting of health financing and social protection programs in conflict-affected settings, particularly whether there are specific categories, such as households suffering from a ‘missing generation’ who might be missed by existing targeting schemes. These insights will inform other countries with conflict legacies about the relevance of such categories.



The descriptive secondary data analysis is now complete for all three countries, and multi-variate analysis of household structures has been undertaken for Sierra Leone. Fieldwork interviews have been conducted in all three countries, and the data is currently being analysed.


Resource lists

Find out more on ReBUILD integration of gender across all its projects, Building Back Better and the RinGs programme.