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The changing health care needs of communities and health system responses in fragile settings

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Presentation given by Tim Martineau of Liverpool School of Tropical Medicine, UK and the ReBUILD Consortium on health systems in fragile settings and their changing needs.
Presented as part of a session at the Fifth Global Symposium for Health Systems Research - 'No Longer Invisible - finally bridging health care, social and societal engagement to build systems for health' in October 2018.

Published in: Health & Medicine
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The changing health care needs of communities and health system responses in fragile settings

  1. 1. The changing health care needs of communities and health systems responses in fragile settings Tim Martineau #HSRFCAS rebuildconsortium.com No longer invisible -- finally bridging health care, social and societal engagement to build systems for health - 9th October 2018
  2. 2. The ReBUILD consortium • Little research on health systems in post- conflict/crisis settings • Decisions made early post-conflict/crisis can steer the long term development of the health system • Initial focus on human resources and finance • Core study countries: Cambodia, Sierra Leone, N Uganda, Zimbabwe
  3. 3. Effects of conflict and crisis on communities and service provision Community Health workers Institutions
  4. 4. . Community Increase in female- headed households children targeted through conscription ‘missing generation’ Reduced access to employment and loss of assets Reduced access to community support mechanismsMovement to different locations gender-based violence and trauma
  5. 5. . Formal health workers Targeted during conflict Resilient staff develop coping strategies; females more likely to stay Family & community support Support from managers Rejection by community Increased shortage and maldistribution Collapse of human resources management and information systems NGOs may support or exacerbate the workforce
  6. 6. . Informal health workers (CHWs) Reduced opportunities for females to be CHW May re-inforce gender inequity Better bridge to community Inadequate supplies; poor recognition by community Integration with formal health workers and system required From study in Sierra Leone, Liberia and DRC CHWs out of pocket
  7. 7. . Institutions Disruption of existing institutions Influx of donors/ int’l agencies Power imbalance with weak local institutionsPoor coordination of resource flows Unpredictability of external support
  8. 8. Rebuilding of responsive health systems and institutions key for community health in fragile contexts Community Health workers Institutions
  9. 9. rebuildconsortium.com @rebuildrpc #HSRFCAS Visit us on Stand 21 in the Exhibition Hall

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