Research for stronger health systems during and after crisis

Communities

Health financing policies that support universal access to health care without causing impoverishment are critical for health and economic development in any setting. Vulnerable populations that are affected by a history of conflict require particular attention to ensure that their households, communities and societies are not permanently scarred by the legacy of that conflict.

During and after conflict or crisis, household structures change. In many conflicts, men are significantly more likely to die than women, conflict or crisis can create a ‘missing generation’. Conflict can also create new vulnerabilities. Through these and other household changes, conflict and crisis affect the ways households can access health care, and the poorest households can be worst hit, despite efforts to target healthcare interventions at such households.

ReBUILD’s research on health financing has specifically examined the interaction between health systems, financing policies and conflict in all four of ReBUILD’s study countries, and is helping to understand how some of the particular effects of conflict on poor households affect how they can access healthcare. Some of the findings from the research on health financing has informed the theme of communities; a theme which ReBUILD will continue to explore through additional research during the next 2 years.

Some sub-themes which are emerging include:

Household structure

Conflict has impacts on demographic structure and in consequence, on household structure.

In addition to an increase in female headed households, children may have been targeted through conscription, or have been more vulnerable to the indirect impacts of conflict, causing a ‘missing generation’ affecting both demographic, household and extended family structures.

These changes can affects the extent to which people are facilitated to access health care; and are protected from impoverishing costs.

Axes of vulnerability

Poverty, gender, and age are generally associated with capacities for resilience or vulnerabilities in all communities.

Conflict creates new vulnerabilities, for example by increasing the prevalence of disability and of female headed households that may for example be disadvantaged in labour markets.

Sometimes these dimensions are also sources of resilience – in some contexts, female headed households have been shown to prioritise health expenditure more than male headed ones.

Accessing healthcare

In the absence of sufficient resources at household level or from the extended family, poor households can struggle to access healthcare.

They can also end up excluded from the community support mechanisms, based on reciprocal small loans and gifts, which are important sources of resilience to health related shocks during conflict affected periods.

People’s access to health care is therefore affected by changes to household and extended family structures especially the balance between productive and non-productive household members.

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