Health systems strengthening and resilience-building in fragile and conflict-affected settings: experiences and operational perspectives of international NGOs
While health systems strengthening is a common term in global health and is acknowledged as essential to sustainable improvements to health outcomes, it remains conceptually and practically problematic. It is difficult to define and even more difficult to measure.
The proliferation of global health initiatives and direct country assistance in recent decades has increased the availability of funding and technical assistance to health systems. However, this has, on the whole, been delivered in a vertical, disease-focused way, further fragmenting and weakening health systems and encouraging donor dependency.
FCAS present a further challenge for health systems strengthening. In these settings, responses that address immediate health needs while strengthening the health system in the long term are needed. These impact on recovery, development, and peace and state-building. However, factors such as weak governance, the presence of non-state actors in service provision and siloed and fragmented external responses complicate the picture and possibly contribute to inefficient and inequitable health systems.
Building on the 2022 Action for Global Health brief on HSS in FCAS which covers the “what to do” questions, this study explored the “how to do” questions for health systems strengthening programming in FCAS, at the intersection between humanitarian and recovery phases. The study does not aim to be a conceptual reflection or a comprehensive review of the existing evidence. Rather, it aims to gather the experiential and operational perspectives of practitioners who participated in the research, based on the acknowledgement of the importance of their views and richness of experiences.