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Evidence to enhance health services in conflict-affected areas


ReBUILD for Resilience examines health system resilience in fragile settings, generating evidence on strategies that can enhance resilience and strengthen health services. ReBUILD is an international research consortium, funded by the UK government, with partners in Lebanon, Myanmar, Nepal, Sierra Leone and the UK. The consortium produces high-quality, practical, multidisciplinary and scalable research that can be used to strengthen health systems and improve the health and lives of many millions of people.

OPM has practical and analytical expertise in health systems resilience through research, evaluations, technical assistance and programme implementation in a wide range of fragile and shock-prone settings. We use this experience and our policy networks to support and extend ReBUILD research, and to maximise the impact of ReBUILD findings.

The challenge

Health systems in fragile settings face severe resource constraints, and shocks such as epidemics, floods, drought and conflict compound their problems. Shocks have both short and long-term effects on core health system capacities - such as health workers, supply chains and financing. Shocks also affect communities’ ability to access whatever services are available, often creating financial and physical barriers. At the same time, shocks often create new demands on health services – such as management of malnutrition due to increased food insecurity, heightened infection control, or treatment for new diseases, as seen with COVID-19.

Some health systems collapse under the pressure of shocks, unable to provide services. Others make maladaptive responses that negatively affect health care. In other cases, additional needs can be absorbed by the existing health system, there are short-term changes to cope with shocks, or the system undergoes transformation, with longer-term changes that improve future resilience.

There is limited evidence about how to develop stronger, more resilient health systems that can manage shocks and provide Universal Health Coverage in fragile settings. ReBUILD seeks to meet that need. We study how health systems respond to shocks and stressors, to identify strategies that enable delivery of gender-equitable care and high-quality health services

Our approach

OPM is an associate partner within the ReBUILD for Resilience research consortium. We bring wide-ranging practical and analytical experience of health systems in fragile and shock-prone settings, including technical assistance, research and evaluation in countries such as Bangladesh, Ethiopia, India, Kenya, Mozambique, Nepal, Nigeria, Pakistan and Sierra Leone. Our work in these contexts has covered a range of shocks – such as floods in Pakistan, food insecurity in Ethiopia, and more recently COVID-19 in many of these countries. Examples include research on health system shock-responsiveness in several countries through Maintains , research on the effects of COVID-19 on essential services in Bangladesh, research and technical assistance for the government of Ethiopia to build disaster resilience, and technical assistance in Nepal, Pakistan and Ethiopia to manage COVID-19. Our work covers a range of health system dimensions, including governance, health workers, information and early warning systems, financing, community engagement, donor support and the impacts of shocks on women and vulnerable groups. 

This work provides considerable learning and opportunities that can contribute to ReBUILD’s research aims. We use our experience to contribute thematic and methodological expertise, and leverage synergies with OPM work to extend ReBUILD’s research and impact. Activities include synthesising OPM research on COVID-19 to identify cross-country lessons on health systems resilience and linking related ReBUILD and OPM research projects; this enables mutual learning and wider cross-country comparison. We will also use our policy networks and technical assistance opportunities to support dissemination and use of ReBUILD findings. A first initiative involves bringing together findings from OPM projects on community health worker experiences during COVID-19, and on the role of coordination and partnerships for emergency response. 

Outcomes and wider impacts

ReBUILD will provide high-quality practical evidence that can be used by governments and development partners to strengthen health systems in fragile settings. By identifying strategies that can enhance resilience and health system capacity to manage shocks and stresses, ReBUILD’s research can help to build Universal Health Coverage and promote equitable health services. OPM and other ReBUILD partners are working closely with country stakeholders in research design and implementation, to ensure that research responds to practical policy needs and supports decision making.

Partners: LSTM, Queen Margaret University, Burnet Institute, COMAHS, HERD international, American University of Beirut.

Areas of expertise