Research for stronger health systems during and after crisis

A Case Study of Technical Assistance to HIV Services in Cote d’Ivoire in the Context of Civil Unrest Following the Disputed Presidential Election of 2010


Martina Lembani1, Helen de Pinho2, Peter Delobelle1, Christina Zarowsky1,3 & Alastair Ager2

1 School of Public Health, University of Western Cape, Cape Town, South Africa
2 Mailman School of Public Health, Columbia University, New York, USA
3 University of Montreal, Quebec, Canada

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.

Resilience is now a dominant concept underpinning development and humanitarian support in contexts vulnerable to crisis, including conflict. This paper is an analysis of the disruption of HIV services in Cote d’Ivoire following the disputed presidential election of 2010.

The paper makes a number of Key Points:

  • The health system in Cote d’Ivoire displayed significant resilience in the context of the disruption following the disputed Presidential election of 2010
  • Continuity of ART actually increased during the course of the crisis; coverage of other HIV services decreased during the crisis but later rebounded
  • Several factors fostering such resilience were identified including co-ordination and task shifting, flexibility in drug supplies, staff motivation and availability, service prioritization and external support
  • Systems modelling provided a mechanism to enable stakeholders to articulate a vivid picture of the interplay of key factors seen to influence response to the crisis
  • The methodology developed for this post hoc analysis appears promising for planned real-time case studies of health systems resilience

Read the full report: A Case Study of Technical Assistance to HIV Services in Cote d’Ivoire in the Context of Civil Unrest Following the Disputed Presidential Election of 2010