Resources from ReBUILD’s work on health financing in conflict-affected and post-conflict settings

Below are details of outputs from ReBUILD’s work on health financing in post-conflict and post-crisis settings. The list is complete as of January 2019.

For more information on ReBUILD’s work on health financing, contact Sophie Witter.

Introduction: ReBUILD’s research on health financing in conflict-affected & post-conflict settings

ReBUILD’s research started with an overview literature review on health financing in post-conflict states, which fed into the development of research projects to fill some identified gaps, including:

• The changes in health financing policies in four countries and how they affected household access and expenditure
• A four-country study on health worker incentives post-conflict
• Social network analysis of aid actors in northern Uganda
• A review of contracting mechanisms in Cambodia
• A review of purchasing mechanisms in Zimbabwe
• A literature review and expert consultation on health financing and gender

During ReBUILD’s extension phase additional projects looked at:

• Performance-based financing (PBF) in fragile and conflict-affected settings, and how contextual factors influence adoption, adaption, implementation and integration of PBF, and how PBF programmes could be improved and ultimately strengthen health systems in FCAS.
• Demographic and distributional impacts of conflicts and implications for health systems. Building on the phase 1 research on health financing, this project aims to understand the implications of conflict-related demographic change for health financing and social protection policies intended to ensure access to healthcare without impoverishing effects.

Resources:

Initial literature review

• Witter, S. (2012) Health financing in post-conflict states: what do we know and what are the gaps? Social Science and Medicine, vol. 75, p.2370-2377.

Health financing policies and household effects

• Ensor, S. Chhun, C., Kimsun, T., McPake, B and Edoka, I. Impact of health financing policies in Cambodia: A 20 year experience Social Science & Medicine, Volume 177, March 2017, Pages 118–126
• Ros, B., Le, G., McPake, B. and Fustukian, S. The commercialization of traditional medicine in modern Cambodia Health Policy and Planning, 2017, 1 – 8, czx144
• Ensor, T., So, S. and Witter, S. (2016) Exploring the influence of context and policy on health district productivity in Cambodia. Cost effectiveness and resource allocation, 14:1.
• Edoka, I., Ensor, T., McPake, B., Amara, R., Tseng, FM and Edem-Hotah, J Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone’s free health care initiative Health Economics Review (2016) 6:19 DOI 10.1186/s13561-016-0096-4
• Edoka, I., McPake, B., Ensor, T., Amara, R., Edem-Hotah, J. (2017) Changes in Catastrophic Health Expenditure in Post-Conflict Sierra Leone: An Oaxaca-Blinder Decomposition Analysis. International Journal for Equity in Health 16:166
• Buzuzi, S., Chandiwana, B., Munyati, S., Chirwa, Y., Mashange, W., Chandiwana, P., Fustukian, S. and McPake, B. (2016). Impact of user fees on health care seeking behaviour and financial protection during the crisis period in Zimbabwe: A life history approach. ReBUILD RPC Working Paper
• A strong public health sector key for health system resilience in Gulu district, northern Uganda ReBUILD RPC Brief (Uganda)
• ReBUILDing Health Systems Beyond Health Facilities ReBUILD RPC Brief (Uganda)

Performance-based financing

• Bertone, MP., Wurie, HR., Samai, M. & Witter, S. (2018) The bumpy trajectory of performance-based financing for healthcare in Sierra Leone: agency, structure and frames shaping the policy process Globalization and Health 14:99

• Bertone, M., Falisse, J-B., Russo, G. and Witter S. (2018) Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems. PLoS ONE 13(4): e0195301

• Bertone, M., Jacobs, E., Toonen, J., Akwataghibe, N. and Witter S. (2018) Performance-based financing in three humanitarian settings: principles and pragmatism Conflict and Health 12:28

• Performance-based financing in fragile and conflict-affected settings – a summary Witter, S. & Bertone M. (2018) ReBUILD Briefing paper
• Bertone MP, Lagarde M, Witter S, (2016) Performance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone.  BMC Health Services Research 16:286

Performance-based financing videos

• Introduction to performance-based financing – Sophie Witter looks at performance-based financing as a way to build strategic purchasing in fragile and conflict-affected states – potentials and pitfalls.
• Health financing in fragile and conflict-affected states – insights from preparatory work by Professor Witter and Dr Maria Bertone for a World Health Organization paper.
• The bumpy trajectory of performance-based financing in Sierra Leone: unpacking the role of external actors – by Maria Bertone.
• Performance-based financing in fragile and post-conflict states – a summary of ReBUILD’s work by Maria Bertone.

Contracting in Cambodia

• Vong, S., Raven, J. and Newlands, D. (2018) Internal contracting of health services in Cambodia: drivers for change and lessons learned after a decade of external contracting BMC Health Services Research 18:375
• Vong, S., Raven, J. and Newlands, D. 2015. Understanding contracting in Cambodia: the performance of contracting and non-contracting districts in extending primary health coverage: analysis of secondary data. ReBUILD RPC Research Report
• Vong, S., Raven, J. and Newlands, D. 2015. Understanding contracting in Cambodia: findings from interviews with key informants and health service managers and providers. ReBUILD RPC Research Report

Financing for universal health coverage in Zimbabwe

• MoHCC, TARSC, Atchison, KIT, Zeparu (2015) Evidence and proposals for advancing equity and universal coverage of health services in Zimbabwe Policy Brief, TARSC/MoHCC, Harare. (This policy brief outlines the main findings and proposals from the project conducted by ReBUILD’s partners in Zimbabwe on Rebuilding the foundations for universal health coverage with equity in Zimbabwe.)
• MoHCC, NIHR, TARSC (2015) National Research Forum: Evidence for advancing Universal Health Coverage in Zimbabwe, Conference Report, 19 -20 March 2015, Harare
• Gwati G MoHCC (2013) Desk Review for Purchasing Arrangements for Public Health Services in Zimbabwe Harare, MoHCC, with TARSC Zimbabwe
• ZEPARU (2014) Desk Review of institutional arrangements for health financing in Zimbabwe,ZEPARU, TARSC, MoHCC, EQUINET in the ReBUILD project: Harare
• Vaughan K, Toonen J, Berghuis-Mutubuki E, Dieleman M (2014) Desk Review of institutional arrangements for health financing in selected African countries, KIT Netherlands with TARSC, MoHCC Zimbabwe

Health financing and gender

• Witter, S., Govender, V., Ravindran, S. and Yates, R. (2017) Minding the gaps: health financing, universal health coverage and gender. Special edition on gender and ethics, Health Policy and Planning.
• Ssali, S. and Theobald, S. (2016) Using life histories to explore gendered experiences of conflict in Gulu District, northern Uganda: Implications for post-conflict health reconstruction South African Review of Sociology Volume 47, Issue 1, 2016

Cross-cutting materials

• Briefs on priority research topics for health systems in crisis-affected contexts, ReBUILD, 2017/18.
  • Resilience of health systems during and after crises – what does it mean and how can it be enhanced?
  • Developing inclusive health systems in crisis-affected settings
  • How to move towards universal health coverage in crisis-affected settings: lessons from research
  • How do different types of provider affect access to effective and affordable healthcare during and after crises?
  • The political economy of crisis-affected settings: what does it mean for investments in health systems?
  • Do health systems contribute to reduced fragility and state-building during and after crises?
  • Sustainability of health systems in crisis-affected settings: lessons for practice
  • Developing health system research capacity in crisis-affected settings: why and how?
  • What do we know about how to respond to humanitarian crises in ways that also contribute to subsequent stronger health systems?
  • Performance-based financing in fragile and conflict-affected settings: what are the opportunities and challenges?
    

• Ager, A., Lembani, M., Mohammed, A., Ashir, GM., Abdulwahab, A., de Pinho, H., Delobelle, P. and Zarowsky, C. (2015) Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building. Conflict and Health 2015 9:30
• Martineau, T., McPake, B., Theobald, S., Raven, J., Ensor, T., Fustukian, S., Ssengooba, F., Chirwa, Y., Vong, S., Wurie, H, Hooton, N and Witter, S. (2017) Leaving no one behind: lessons on rebuilding health systems in conflict and crisis-affected states. BMJ Global Health Jul 2017, 2 (2)

• Health financing policy in conflict-affected settings: lessons from ReBUILD research. ReBUILD briefing paper (2016)
• Woodward, A., Sondorp, E., Witter, S. and Martineau, M. (2016) Health systems research in fragile and conflict affected states: a research agenda-setting exercise. Health Research Policy & Systems.
• Universal health coverage amid conflict and fragility: ten lessons from research. (Witter, S., Dec 2015, Lancet Global Health blog)
• McPake, B., Witter, S., Ssali, S., Wurie, H., Namakula, J. and Ssengooba, F. (2015) Ebola in the context of conflict affected states and health systems: case studies of Northern Uganda and Sierra Leone. Conflict and Health; 9; 23.
• Percival, V., Richards, E., MacLean, T. and Theobald, S. (2014) Health systems and gender in post-conflict contexts: building back better? Conflict and Health 2014, 8:19
• McPake, B., Witter, S., Ensor, T., Fustukian, S., Newlands, D., Martineau, T. and Chirwa, Y. (2013) Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources. Human Resources for Health, 11(1):46.