Who governs health systems in fragile and conflict-affected settings?

Who governs health systems in fragile and conflict-affected settings?

Lessons learned on effective factoring of political dynamics to achieve UHC

Who governs health systems in fragile and conflict-affected settings?

Lessons learned on effective factoring of political dynamics to achieve UHC

This session will unpack the political economy of health systems’ fragmentation in fragile and conflict-affected settings and identify opportunities for engaging political forces alongside technical solutions for its prevention. A variety of contexts will set the scene for a debate and an exchange with the audience and an innovative research agenda will be outlined.

Background information

In many fragile and conflict-affected settings (FCAS), the health system is characterized by highly fragmented health governance, often lasting for extended periods, or even becoming the norm. The dominating discourse tends to analyze the problem from the perspective of intrinsic dysfunctionalities of the local structure, from lack of coordination and intersectoral collaboration’s capacity to weak accountability mechanisms and political will. While these are important contributing factors, arguably nowhere, but in fragile environments do the dominating governance arrangements best mirror at smaller scale and are influenced by the long-standing fragmentation of the global governance setup at large, which the COVID crisis has largely exposed. Political barriers, alongside powerful perverse systemic incentives, converge with structural incapacity to discourage joint action and promote the organic development of parallel healthcare systems, which feed fragmentation in almost equivalent proportion as they contribute to healthcare delivery’s resilience. The health sector in FCAS is crowded with a variety of actors (from the aid community to civil society, faith-based institutions, diaspora groups, and business investors) that play a subsidiary role to the national agenda while inevitably engaging with local authorities and with one another in political dynamics. Developing strategies for reducing fragmentation, engaging in constructive policy dialogue, and effectively distributing available resources across the health system has become a constant priority in national development programmes and a core business of external health system strengthening support.

This webinar intends to provide an overview of a diverse range of mechanisms deployed to reduce fragmentation of health systems’ governance in the interest of the UHC agenda and unpack their comparative effectiveness or, at least, identify enabling factors leading to progress. Additionally, the session will explore both the political economy behind health system fragmentation and opportunities to prevent it by engaging political forces alongside technical solutions. Political aspects of health systems’ (failing) governance have traditionally been kept at a prudent distance from the research agenda in FCAS. Decades of attempts to provide exclusively technical solutions in contexts that seem to resist the concept of governance in the first place represent a fertile ground to initiate a debate about the building blocks of efficient governance models that contribute to the achievement of UHC (maybe one that embraces fragmentation?). Identifying these building blocks through a case studies approach is a first step towards reinventing health systems’ policy starting from concrete realities.


Moderator: Dr. Barbara Profeta

Dr. Profeta has twenty years of overseas experience in humanitarian and development work, across a variety of positions and organisations, including the Red Cross Red Crescent Movement, the UN family, NGO, and private consulting firms. She has been managing offices and programmes in a dozen of different countries on four continents, with a major focus on fragile and conflict-affected environments. Holder of a Ph.D. on International Public Health and Policy at the London School of Hygiene and Tropical Medicine, since 2008 Barbara has engaged in programmatic and advocacy work related to the strengthening of distressed health systems and linking research and operations. Barbara is currently working as Senior Health Advisor for Global Programme Health and Eastern Cooperation Domain at the Swiss Development Cooperation Agency. In parallel, she is a board member of the Thematic Working Group on Fragile and Conflict-Affected States and an advisory group member of the Private Sector Engagement Thematic Working Group attached to the Health Systems Global research network. Since 2021, she is also an Honorary affiliate at the Institute of Development Studies (UK) and Sussex University.  Her main areas of interest: Health systems’ governance, distressed health systems, health systems’ redesign, mixed health systems, private sector in health, informal economies in the health sector, the role of China in global health, role and future of the aid industry, local solutions, south-south partnerships in development, equity in research.

Gaspar Bergman

Having served in the United Nations system (UNICEF, UNDP, UNHCR, UN Department of Political and Peacebuilding Affairs) for over 15 years, Gaspar has led and managed health system interventions in conflict-affected areas of Eurasia (Georgia, Moldova, Ukraine) including ‘territories not under government control’. In his capacity as UNICEF Chief of Field Offices, he leveraged the capacity of humanitarian, recovery, and development instruments to ensure continued health service provision and health system reform in transitional contexts. In his present role as consultant to the Federal Department of Foreign Affairs of Switzerland, Gaspar provides support to strategic health initiatives designed and implemented in response to the COVID-19 pandemic. Since 2020, Gaspar also serves the International Federation of Association Football (FIFA) as a technical development expert and as a mentor to football federations in Asia (Bangladesh, Kyrgyzstan, Turkmenistan). Holds law degrees from the University of Oxford, Kyiv University, and Harvard University.


Haja Ramatulai Wurie

Haja Ramatulai Wurie is the ReBUILD for Resilience project lead at the College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone. She is also a senior lecturer in Biochemistry and head of the Biochemistry department at COMAHS. Haja is a multi-disciplinary health researcher involved in a range of health systems strengthening projects (including the ReBUILD project) and is at the forefront of research capacity building at COMAHS.



Mohamed Ali AgAhmed

Mohamed Ali AgAhmed is a Malian doctor with a Ph.D. in Community Health obtained in Canada. He worked as a front-line clinician in Mali before started working for various international organizations such as Luxembourg Cooperation, Médecins Sans Frontières, and Action Contre la Faim. He is currently a researcher at the Institute of Tropical Medicine of Antwerp (Belgium) and an associate researcher at the Faculty of Medicine and Odonto-Stomatology of Bamako (Mali). He is the main facilitator of the network of experts called Francophone Africa and Fragility (AFRAFRA) which objective is to support the health systems of French-speaking African countries affected by conflicts or other disasters.


Mostafa Hunter

Mostafa Hunter is passionate about policy innovations to advance equity and integrity in healthcare systems and fight corruption. Originally an eye surgeon, he made a career switch 15 years ago. He has taken the lead on the development of several innovative approaches, conceptual frameworks, and guides in fields of governance and anti-corruption and has been an advisor to several UN agencies. Currently, he is an Advisor to the UNDP on Corruption Risk Management leading the development of the UNDP Methodology for Sectoral Corruption Risk Management and its implementation in several countries. He has also been a consultant to the WHO Headquarters for the development of a Decision-making Model to Strengthen the Stewardship Role of Member States to Engage the Private Sector for Universal Health Coverage and to the WHO-EMRO on developing a Policy-maker Guide for Strengthening Accountability in Healthcare Systems. He has served on the WHO Advisory Committee on the Governance of the Private Sector between 2018-2020 and is the Lead Founder and Chairman of the Healthcare Governance and Transparency Association (HeGTA). His awards include the “2011 Rising Star of Corporate Governance” by the Yale School of Management, being named a Star in 2012 by the Global Proxy Watch, the 2016 Cairo University Faculty of Medicine Shield of Honor, was part of the team which was awarded the World Bank Vice-presidential Unit Team Award of Excellence for 2016, and in 2018 the Honor of Outstanding Alumni from the DAAD (German Academic Exchange Service) Alumni Association of Egypt.

Osvaldo Enrique Artaza Barrios

Osvaldo Enrique Artaza Barrios is a Chilean pediatrician, has obtained a Master’s in Health Administration, is a former hospital director, a former Chilean health minister, a former consultant for the Pan American Health Organization, and the Dean of the Faculty of Health and Social Sciences at the University of the Americas.



Marina Madeo

Marina Madeo is a medical doctor and public health professional with over twenty years of experience in providing technical support to health programmes in developing countries, including fragile states. Her fields of interest and expertise include primary health care; health systems strengthening; health sector policies, strategies, and programmes, sector-wide and by component or specific disease control; health sector coordination, partnership, and governance; institutional capacity building; reforms and innovative financing; aid effectiveness. She currently invests her expertise and energy in contributing to strengthen health systems and build capacities, with a particular interest in fragile contexts. Marina is interested in people, their needs, and their potentials.