Presentation given by Tim Martineau as part of a Satellite Session at the Fifth Global Symposium on Health Systems Research on 9th October 2018: 'No longer invisible - finally bridging the divide between health care, social and societal engagement to build systems for health', organised by CORE Group and Save the Children.

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

3. 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

4. Effects of conflict and crisis on
communities and service provision
Community
Health
workers
Institutions

5. .
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

6. .
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

7. .
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

8. .
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

9. Rebuilding of responsive health
systems and institutions key for
community health in fragile contexts
Community
Health
workers
Institutions

10. rebuildconsortium.com
@rebuildrpc #HSRFCAS
Visit us on Stand 21 in the Exhibition Hall