Supporting knowledge sharing through the Thematic Working Group on Health Systems in Fragile and Conflict-Affected Settings

Fragility, violence and conflict are critical development challenges, affecting, eroding and hampering efforts to build healthy and prosperous societies. In affected settings innovative, timely and relevant evidence to develop stronger and more resilient and responsive health systems is essential. It is important that such evidence is generated in partnership with key local stakeholders with particular attention given to the interface between research, policy and practice. Broad networks bringing together actors going beyond academic and donor circles could play a critical role.


What problem is being addressed?

Health systems research in fragile and conflict-affected settings (FCAS) is a growing area of interest for researchers and donors. However, the growth in research focus is relatively recent and still faces important challenges. ReBUILD research has shown that research in FCAS is beset by problems which are less pressing in more stable environments (see Woodward et al – opens new tab). Importantly, there is a need for platforms and networks to link actors across different groups, including local policy makers and practitioners as well as donors and global health institutions, to share knowledge and increase uptake. Indeed, guidance on health systems strengthening and resilience is often not specific to fragile settings, which need tailored and adapted advice, often not available to practitioners, and there is little cross learning between groups and regions.


What did we do?

Health Systems Global (HSG) [opens new tab] is the global membership organization of researchers, decision-makers and implementers dedicated to promoting health policy and systems research and knowledge translation. HSG has ten Thematic Working Groups (TWG) on key sub-topics, one of which is focused on health systems in fragile and conflict-affected settings (TWG FCAS) [opens new tab].

Tim Martineau (LSTM) and Suzanne Fustukian (QMU), members of ReBUILD worked with Health Systems Global from its inception to help guide and develop thinking around health systems in fragile and shock-prone settings. They were among the co-founders of the TWG in 2014 and continued to actively work within it and hold positions on the Steering Committee. In 2020, ReBUILD researcher Maria Bertone (QMU) joined the TWG Steering Committee as Vice-Chair, along with Egbert Sondorp (KIT/ReBUILD Consortium Advisory Committee), Barbara Profeta (Swiss Development Agency), Ali Ardalan (WHO) and Sharon Low (The Knowledge House). Maria’s role has further established the central role of ReBUILD in driving the TWG FCAS’s debates and activities and reinforced ReBUILD’s engagement with the community of researchers and practitioners working on health systems in fragile settings.

As of June 2023, TWG had 2,065 members across the globe, including researchers, practitioners, technical advisers and implementers, policy makers, donors, and frontline providers of health in fragile settings. It has established itself as an important convening body for those working in FCAS, where members can exchange knowledge and information and develop networks through the LinkedIn and Google Groups [both open new tabs], a newsletter and an annual “business meeting” open to all members. Face-to-face meetings are held, usually around the Global Symposium on Health Systems Research which happens every two years.

ReBUILD’s role as been critical for the TWG, not only as part of the core group in charge of providing strategic direction, but also in terms of supporting communications and knowledge generation and sharing, producing or co-producing key content, such as blog posts, webinars and web features.

• ReBUILD members have maintained a core role in the TWG for almost 10 years, ensuring evidence from ReBUILD is regularly fed into the debates, knowledge disseminating activities and advocacy of the TWG and the communities it represents.
• The initial strategic focus of the TWG involved advocacy and awareness raising to improve the profile of health systems research in FCAS which at the time was a relatively underdeveloped topic. In 2016, ReBUILD members co-designed and co-conducted a study of health systems research needs in FCAS, producing published articles (eg Woodward et al – opens new tab) and briefing papers [opens new tab]. This work has shaped the TWG’s activities as the Steering Committee has continued to use this work as a roadmap for strategic planning to ensure their work is aligned with stated needs within the sector.
• Through the TWG, ReBUILD members have worked on a seminal learning and knowledge exchange resource, through the Eldis resource collection [opens new tab] and key issue guides on “building pathways for recovery” [opens new tab] and “critical factors in rebuilding health systems after crises” [opens new tab].
• ReBUILD has actively sought to bring its research to the TWG, engaging in agenda setting events and outputs, supporting communications for the group by contributing blogs, and engaging in and co-sponsoring knowledge sharing events, such as webinars, which also included sharing ReBUILD-generated evidence. For example:

October 2020: ReBUILD researchers Sally Theobald, Kate Hawkins, Sophie Witter and Haja Wurie, co-authored the HSG/TWG blog post on “Solidarity and psychosocial support: Healthcare workers on World Mental Health Day” [opens new tab]

December 2020: ReBUILD co-director Sophie Witter authored a TWG blog on “Supporting health system resilience – if not now, when?” [opens new tab]

July 2021: ReBUILD researchers co-organised a TWG webinar on “The role of Community Health Workers in future proofing health systems in fragile and conflict-affected settings” [opens new tab], and authored a related blog post [opens new tab]

September 2021: Building on that webinar and on ReBUILD’s work on CHWs, ReBUILD research was presented at the TWG webinar “Close-to-community providers in fragile settings and vulnerable communities during crisis: Gender and COVID-19” which included a discussant from UN Women. The webinar discussed the vital role pf CHWs in supporting their local health systems, particularly in fragile and shock-prone settings and during times of crisis, such as the COVID-19 pandemic. This webinar heard how gender, COVID-19 and fragility interplayed in the work and lives of health care providers in Brazil, Lebanon, Sierra Leone and Nepal.

April 2023: the TWG launched its new plans for the lead up to the next HSR Symposium in Nagasaki (November 2024). Under the strategic leadership of the Steering Committee, of which Maria Bertone (QMU/ ReBUILD) is Vice-Chair, strong links with the ReBUILD research agenda are being reinforced, in particular a focus on reflecting on the concept/label of “fragility” and its theoretical and practical value, and on the principles and practices of health system strengthening in FCAS.



Through its longstanding engagement in core strategic roles within the TWG, ReBUILD has influenced the community of researchers and practitioners working on health systems in fragile settings, ensuring that its work is focused on the most pressing issues in the field, that evidence is shared and that strong learning networks are created:

The Eldis repository [opens new tab], mostly put together by ReBUILD researchers, has played (and continues to play) a critical role in influencing the understanding of health systems in FCAS beyond the research community and providing resources for teaching and learning.
• ReBUILD members have guided the critical advocacy work undertaken by the TWG in its early years, to raise the profile of health systems research in FCAS and establishing a research agenda. Such work was extremely successful. Health systems research in these settings is now a well-established (sub)field, and research priorities defined in the seminal ReBUILD co-authored paper are at the core of its growth.
• As TWG leads, ReBUILD members have reinforced their leadership in the field, influencing expert panels and knowledge communities, both by sharing ReBUILD-generated evidence to shape the debates and knowledge sharing and advocacy activities of the TWG, but also strengthening the visibility and legitimacy of ReBUILD as a generator of knowledge. Within the TWG community and beyond, ReBUILD is known and used as a source of high-quality, relevant guidance and evidence.


Further information

There are other ReBUILD for Resilience case studies here 


Image: Homepage of Health Systems Global’s Thematic Working Group on Health Systems in Fragile and Conflict-Affected Settings – visit the site here [opens new tab]