Research for stronger health systems post conflict

Health Systems Resilience: A Complex Adaptive Systems Analysis

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Health Systems Resilience: A Systems Analysis is a ReBUILD affiliate research project applying a systems dynamics approach to understand, predict and identify mechanisms that influence the resilience of health systems in contexts of adversity. The project is implemented by the Mailman School of Public Health, Columbia University, in collaboration with the School of Public Health, University of Western Cape. It has been funded under ReBUILD's responsive fund.

Resilience is now a dominant concept underpinning development and humanitarian support in contexts vulnerable to crisis, including conflict. Two papers from this research so far examine the resilience of the health systems in regions affected by recent conflict. The first is an analysis of the disruption of HIV services in Côte d’Ivoire following the disputed presidential election of 2010. The second looks at the health system in Yobe state in northern Nigeria during the Boko Haram insurgency, ongoing since 2011.

In both the case studies, the conflict and disruption (population migration, transport restrictions, fear and uncertainty amongst both health service users and health workers) did have a significant impact on both access to, and provision of health services. However, both health systems showed significant resilience in some important areas. And some key lessons emerge that could inform those in other contexts facing similar conflict-related challenges.

For example, a range of measures and responses ensured that supply of drugs for anti-retroviral therapy was largely maintained in Côte d’Ivoire, whilst other measures helped protect drug supplies during much of the crisis in Yobe. And crucially, in both case studies, motivation, availability and flexibility especially amongst lower cadres and locally recruited staff meant that key services continued to be provided throughout much of the crisis period. Community support was also important in fostering resilience, as was political will and incentives for staff.

The third and final case study has now also been published, and focuses on chronic health systems challenges in one district of Eastern Cape province in South Africa.

The systems modelling approach provided a mechanism for stakeholders to articulate a vivid picture of the interplay of key factors in the response to crisis. A new resource, Scripts to Support Group Model Building; A Guide for Participatory  Systems Analysis, has now been published. This guide documents twelve of the 'scripts' that were found to be most valuable during the course of the completed case studies.