Research needs and challenges for health systems strengthening in fragile and conflict-affected states
By Nick Hooton, ReBuild and member of the HSG Thematic Working Group on Health Systems in Fragile and Conflict Affected States
What areas of health systems research in fragile and conflict affected states require particular attention for further enquiry and investment? And what are the challenges that need to be addressed for effective health systems research in these settings?
With fragile and conflict-affected states (FCAS) lagging markedly behind in meeting international health goals, these are really important questions to answer. Donors and implementers are increasingly focusing on trying to address the health challenges in fragile settings. Health systems strengthening is often an important component of their activities, and good evidence to inform such health systems policy and practice is crucial.
Despite this interest, health systems research in FCAS remains relatively underdeveloped, and it is therefore important to have guidance about what research to focus on, and to make most efficient use of research funds. However, there had previously been no organised discussion or consensus-building on a global research agenda for health systems in FCAS. To fill this gap, the HSG Thematic Working Group on Health Systems in Fragile and Conflict Affected States (TWG-FCAS), with funding from the Wellcome Trust, designed and conducted a research-needs setting exercise, guided by a group of 30 experts, including academics, policy makers, implementers and donors. In addition, the study explored the challenges involved of doing health systems research in these contexts.
Between August 2014 and September 2015 a scoping review and stakeholder consultation was carried out, using an online survey, face-to-face and online group sessions, including a webinar and feedback through LinkedIn. This process has resulted in a research agenda covering a broad range of topics related to transition & sustainability, resilience & fragility, equity & gender, accessibility, capacity building, actors & accountability, community, health care delivery, health workforce and health financing.
This agenda is not an end in itself, but is a starting point for discussion on ways forward for health systems research in FCAS. A key challenge, however, is a lack of sufficient, longer term and flexible funding to promote targeted research priorities using research designs and processes that take the fragility into account.
These findings have now been summarised in two briefing papers, one outlining the findings on the research agenda, and another on the research challenges. A paper from this study has also been published in Health Research Policy and Systems.
A wide range of stakeholders participated in the different stages of the exercise, and this process of engagement may have been just as valuable for building a community of researchers as the product. It is now important to drive forward the research agenda. Without both a higher profile and deeper focus for this area, there is a real risk that FCAS will continue to fall behind in global health and development goals.
The TWG-FCAS will continue to be a focal point for discussion on ways forward for health systems research in FCAS. This will include activities in the upcoming 4th Global Symposium on Health Systems Research, and through ongoing engagement in the LinkedIn group – now with over 500 members.
If you are working or interested in health systems in FCAS, whether as implementer, policy maker, donor, researcher or other role, do join the TWG-FCAS and contribute to the process of creating and supporting the use of new knowledge for stronger health systems in these challenging settings.
The TWG-FCAS research needs study was conducted by Egbert Sondorp (KIT) and Aniek Woodward (LSHTM). The TWG-FCAS gratefully acknowledges the Wellcome Trust for funding this research activity
- Briefing paper 1: Health systems research in fragile and conflict affected states: a research agenda-setting exercise
- Briefing paper 2: Health systems research in fragile and conflict affected states: a qualitative study of associated challenges
- Journal article: Health systems research in fragile and conflict-affected states: a research agenda-setting exercise (Woodward, A., Sondorp, E., Witter, S. and Martineau, T., 2016) Health Research Policy and Systems 14:51 DOI: 10.1186/s12961-016-0124-1)
