ReBUILD

ReBUILD: Health systems strengthening post-conflict (phase 2)

(01 April 2017 - 31 January 2019)

Countries: Cambodia, Sierra Leone, Uganda, Zimbabwe, Timor Leste, Liberia, Democratic Republic of Congo, Nigeria and Central African Republic.

��was a multi-partner, multi-country research consortium that began in 2011. It aimed to enable poor people��in post-conflict settings to access effective health care while reducing the costs of healthcare to health systems and those who use them.

In phase 2 (2017-2019), this project had��four main research areas: performance-based financing; human resources for health; community health workers and demographic and distributional impacts of conflicts and implications for health systems. The countries where research��was carried out were Cambodia, Sierra Leone, Uganda and Zimbabwe. New settings for Phase 2 included Timor Leste, Liberia, Democratic Republic of Congo, Nigeria and Central African Republic.

��ݮ��'s��role��in��this project

As well as providing technical co-direction for the full ReBUILD programme, researchers from the Institute for Global Health and Development at ��ݮ�� led in the following areas:

Performance-based financing (PBF)

Our research in this area aimed to understand the proliferation of PBF programmes in fragile and conflict-affected states (FCAS), including humanitarian settings, their impacts on political economy and how they have affected health system purchasing.��

Demographic and distributional impacts of conflict and the impact on household vulnerability: generation, gender and disability (GENDIS)

This area of work researched the uneven distribution of demographic change in three conflict-affected countries and the impact on household vulnerability and health care access.

Thematic Working Group on Health Systems in Fragile and Conflict Affected States

Staff at IGHD are heavily involved in the Steering Committee of the Thematic Working Group (TWG) on Health Systems in Fragile and Conflict Affected States (FCAS), one of 10 TWGs of Health Systems Global. The TWG FCAS brings together researchers, policy makers, funders and implementers working in fragile and conflict affected states to achieve better health, equity and well-being by strengthening health policy and systems research in these challenging contexts.

For information on the full range of ReBUILD projects, see the main

About this project
Partners
Funding
Project objectives
Project publications

Researchers at Queen Margaret University had three main areas of research within ReBUILD. These were focusing on performance-based financing and changing household demographics after conflict.

PBF

Performance-based financing, or PBF, is an incentive scheme where health care providers are paid depending on their performance. As well as examining the PBF programmes in three of the original ReBUILD countries, Uganda, Sierra Leone and Zimbabwe, three new contexts were added to the research: Nigeria, Central African Republic and Democratic Republic of Congo.

This and a hypothesis-led literature review gave insights into both how PBF programmes can evolve and how they can be adapted and implemented in more humanitarian settings.

GENDIS

In Cambodia, Uganda and Sierra Leone, conflict has led to changes in population demographics and hence household structures. The study explored the experiences of selected households that experienced loss or disability from past conflict of key members of their households and in what ways this influenced their lives, livelihoods, health and health care experiences.

The impacts were gendered, with a disproportionate number of males��dying from the direct violence of war, although the experience of abduction and amputation��was experienced by both genders in Sierra Leone and Northern Uganda. Direct violence also led to disability and other trauma (both physical and mental).�� Indirect impacts of conflict on health were also noted, caused -��in part -��by poor health infrastructure and failing or loss of livelihoods.��

Thematic Working Group on Health Systems in Fragile and Conflict Affected States

The work undertaken by the Thematic Working Group on Health Systems in Fragile and Conflict Affected States includes editing a special issue of : , which published 16 papers in 2014-15, and is establishing a resource repository of relevant research studies and practice guidelines, as well as two key issue guides in collaboration with hosted by the , UK.

Find out more about the Thematic Working Group on Health Systems in Fragile and Conflict Affected States over on the main��website.

ReBUILD Consortium was a multi-partner, multi-country research project, with partners from , Sierra Leone, , Uganda, , and the , Zimbabwe.

To find out more about these partners, please see the main

This project was funded with from the British people.

��

To influence national governments, funding agencies, implementing agencies and other bodies such as and PBF communities of practice into developing more context-specific, embedded and sustainable approaches to PBF;

To support the modification of health financing and social protection policy and mechanisms to better assure conflict-affected households’ access to health care;

To explore the new vulnerabilities emerging from conflict in relation to health care access and identify the gaps in social protection policies responding to these vulnerabilities resulting from demographic change.

July 2019 - Academic paper - Witter, S., Palmer, N., Balabanova, D., Mounier-Jack, S., Martineau, T., Klicpera, A., Jensen, C., Pugliese-Garcia, M. and Gilson, L. (2019) Health system strengthening-Reflections on its meaning, assessment, and our state of knowledge International Journal of Health Planning and Management, 34(4).

February 2019 - Research Summary -��This summary document gives an overview of the projects and research themes which have made up ReBUILD’s work, with links to all of ReBUILD’s theme-specific resources lists and complete published outputs online. See this summary over on

January 2019 - Academic paper - Witter, S., Bertone, M.P., Namakula, J., Chandiwana, P., Chirwa, Y., Ssenvonio, A., and Ssengoobe, F. (2019) (How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo Global Health Research and Policy, 4(3).

January 2019 - Blog (French language) - Prof Sophie Witter, Systèmes de santé fragiles et affectés par les conflits: réduire la fracture linguistique.

December 2018 -��Briefing papers��(French language) - French versions of the��briefing papers which were produced earlier in the project. They address key questions on health systems strengthening in settings affected by conflict or crisis. Read the papers over on

November 2018 - Academic paper - Bertone, M. P., Martins, J. S., Pereira, S. M., Martineau, T., and Alonso-Garbayo, A. (2018) Understanding HRH recruitment in post-conflict settings: an analysis of central-level policies and processes in Timor-Leste (1999–2018) Human Resources for Health, 16 (66).

October 2018 - Webinar - Performance based financing in fragile and conflict-affected settings: from research to practice. 31 October 2018.

October 2018 - Academic Paper - Bertone, M. P., Wurie, H., 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. Globalisation and Health, 14 (99).

September 2018 - Briefing paper - a briefing paper which summarises ReBUILD's work towards performance-based financing (PBF) in fragile and conflict-affected states. Read the paper over on

June 2017 and July 2018 -��Briefing papers��- 9 briefing papers have been produced which address key questions on health systems strengthening in settings affected by conflict or crisis. Read the papers over on

June 2018��-��Academic Paper - Bertone, Maria Paola and Jacobs, Eelco and Toonen, Jurrien and Akwataghibe, Ngozi and Witter, Sophie (2018) Performance-based financing in three humanitarian settings: principles and pragmatism. Conflict and Health, 12 (28). ISSN 1752-1505 ��

May 2018 – Academic Paper - Raven, Joanna and Wurie, Haja and Witter, Sophie (2018) Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study. BMC Health Services Research, 18 (1). p. 251. ISSN 1472-6963 ��

April 2018 – Academic Paper - Bertone, Maria Paola and Falisse, J-B and Russo, Giuliano and Witter, Sophie (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. ISSN 1932-6203

February 2018 – Academic Paper - Raven, Joanna and Baral, Sushil and Wurie, Haja and Witter, Sophie and Samai, Mohamed and Paudel, Pravin and Subedi, Hom Nath and Martineau, Tim and Elsey, Helen and Theobald, Sally (2018) What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal. Health Research Policy and Systems, 16 (6). ISSN 1478-4505 ��

January 2018 – Academic Paper - Witter, Sophie and Wurie, Haja and Namakula, Justine and Mashange, Wilson and Chirwa, Yotamu and Alonso-Garbayo, Alvaro (2018) Why do people become health workers? Analysis from life histories in 4 post-conflict and post-crisis countries. The International Journal of Health Planning and Management, 33 (2). pp. 449-459. ISSN 0749-6753 ��

January 2018 – Academic Paper - Witter, Sophie and Brikci, Nouria and Harris, Tim and Williams, Richard and Keen, Sarah and Mujica, Ana and Jones, Alex and Murray-Zmijewski, Alex and Bale, Barbara and Leigh, Bailah and Renner, Ade (2018) The free healthcare initiative in Sierra Leone: Evaluating a health system reform, 2010-2015. The International Journal of Health Planning and Management, 33 (2). pp. 434-448. ISSN 0749-6753 ��

December 2017 – Academic Paper -�� Witter, Sophie and Namakula, Justine and Wurie, Haja and Chirwa, Yotamu and So, Sovanarith and Vong, Sreytouch and Ros, Bandeth and Buzuzi, Stephen and Theobald, Sally (2017) The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts. Health Policy and Planning, 32 (supp_5). v52-v62. ISSN 0268-1080 ��

November 2017 – Academic Paper -�� Witter, Sophie and Wurie, Haja and Chandiwana, Pamela and Namakula, Justine and So, Sovannarith and Alonso-Garbayo, Alvaro and Ssengooba, Freddie and Raven, Joanna (2017) How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia. Health Policy and Planning, 32. (Suppl_3). iii3-iii13. ISSN 0268-1080

October 2017 – Academic Paper -�� Ros, Bandeth and Lê, Gillian and McPake, Barbara and Fustukian, Suzanne (2017) The commercialization of traditional medicine in modern Cambodia. Health policy and planning, 33 (1). pp. 9-16. ISSN 1460-2237

July 2017 – Academic Paper -�� Martineau, Tim and McPake, Barbara and Theobald, Sally and Raven, Joanna and Ensor, Tim and Fustukian, Suzanne and Ssengooba, Freddie and Chirwa, Yotamu and Vong, Sreytouch and Wurie, Haja and Hooton, Nick and Witter, Sophie (2017) Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states. BMJ Global Health, 2 (2). e000327. ISSN 2059-7908 ��

June 2017 – Academic Paper - Ssengooba, Freddie and Kawooya, Vincent and Namakula, Justine and Fustukian, Suzanne (2017) Application of social network analysis in the assessment of organization infrastructure for service delivery: a three district case study from post-conflict northern Uganda. Health Policy and Planning, 32 (8). pp. 1193-1202. ISSN 0268-1080 ��

June 2017 – Academic Paper - Ssengooba, Freddie and Namakula, Justine and Kawooya, Vincent and Fustukian, Suzanne (2017) Sub-national assessment of aid effectiveness: A case study of post-conflict districts in Uganda. Globalization and Health, 13 (1). ISSN 1744-8603 ��

January 2017 – Academic Paper - Witter, Sophie and Bertone, Maria Paola and Chirwa, Yotamu and Namakula, Justine and So, Sovannarith and Wurie, Haja R. (2017) Evolution of policies on human resources for health: opportunities and constraints in four post-conflict and post-crisis settings. Conflict and Health, 10 (1). ISSN 1752-1505 ��

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