Health system governance in settings with conflict-affected populations
Citation: Lokot M, Bou-Orm I, Zreik T, et al. Health system governance in settings with conflict-affected populations: a systematic review. Health Policy and Planning. 2022;37(5):655-74.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding sources: UK Research and Innovation.
What is this? Evidence on how to ensure that health system governance is effective may help those involved in health care in conflict-affected settings.
In this systematic review, the authors searched for studies of health system governance among populations affected by armed conflict. They did not restrict their searches by date or language of publication and did the search in October 2020. They included 32 qualitative and 2 mixed methods studies, three of which were conducted in multiple regions with the others in Africa (12 studies), North America (1), South America (1), Asia Pacific (4), Europe (6) and the Middle East (7). Eight of the studies included multiple populations and the others focused on refugee or asylum-seeking populations (12 studies), internally displaced persons (IDPs) (2), a mixture of refugees or IDPs with host populations (4), post-conflict populations (5) and non-displaced conflict-affected or entrapped populations (3).
What was found: At the time of this review, there was limited evidence on health system governance in settings with conflict-affected populations.
The most commonly described barriers to health system governance were poor coordination, mistrust between stakeholders, lack of financial support, problems with resource allocation and dominance of donor influence.
The most commonly described facilitators to health system governance were collaboration between stakeholders, use of bottom-up and community-based governance structures, inclusive policies and longer-term vision.
The most frequently identified governance principles related to participation and coordination, equity and inclusiveness, and intelligence and information. The least frequently identified related to rule of law, ethics and responsiveness.
Implications: The authors of the review concluded that researchers and donors should support the production of evidence on how to strengthen health system governance in conflict-affected settings. They also stated that there is a need for more theoretically and conceptually informed research on the role of health system governance in settings with conflict-affected populations.
Other considerations: The authors of the review discussed their findings in the context of place of residence.
This summary was prepared by Catherine Haynes, checked by Cristián Mansilla, and finalized by Mike Clarke.