Health systems institutions – the organisations, rules and relationships that apply to the health system – become more complex post conflict and post crisis. The rapid influx of actors and resources means decision making can be uncoordinated, and resources can be inefficiently used, duplicated and fail to deliver the right services.
A key issue in post-conflict health systems institutions is the lack of ownership of national actors during the immediate post-conflict period and afterwards, which coupled with the uncoordinated approach can make long-term health system strengthening more difficult. Decisions made at this time can impact long into the future.
Several components of ReBUILD’s research have informed our findings on this theme, including our research into policy evolution on health financing and human resources for health, as well as the specific project on aid effectiveness, which looked at relationships between agencies implementing health programmes in northern Uganda, using social network analysis. This project also analysed the major dynamics in aid-relationships and aid-effectiveness within the district-level network of health-related agencies.
Sub-themes which have emerged from our cross-cutting analysis of the country-level research are:
Actors and networks
The transition from emergency to post-conflict is a time of immense change and scope, often lacking in policy clarity, implementation capacity and resources.
Changing roles and identities of health system actors in the transition from emergency to post-conflict is also commonly experienced - from humanitarian actors to state actors and development-oriented international NGOs and donors.
New networks can emerge post conflict, but there can be different priorities and approaches to rebuilding health systems between these different actors, increasing the potential for fragmentation in the system.
In post-conflict situations, significant flows of resources to the health system, ranging from human, knowledge and information, financial, to technological, commence once the signals of peace arrive.
To be effective in the recovery of the health system, these flows need to be coordinated and scrutinised by national actors, accountable for decisions.
However, the realities are often of severe fragmentation of existing systems and resources, with decisions over resource allocation often taken by external actors.
Policy and power
The end of conflict may provide opportunities to reconfigure health systems in a pro-poor direction. However, the opportunity may not occur in the immediate post-conflict period due to low national capacity and a lack of coherence due to the presence of the multiple external actors described above.
The lack of national capacity and ability to lead change may also lead to policy being externally driven. Progress towards greater national ownership and direction of policy can be slow and is not linear – dependence on external financing established in the early post-conflict period can increase over time, for example, not diminish.
Short videos: Resource flows & Policy & power
Find more resources relating to ReBUILD's work on Institutions