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Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states
  1. Tim Martineau1,
  2. Barbara McPake2,
  3. Sally Theobald1,
  4. Joanna Raven1,
  5. Tim Ensor3,
  6. Suzanne Fustukian4,
  7. Freddie Ssengooba5,
  8. Yotamu Chirwa6,
  9. Sreytouch Vong7,
  10. Haja Wurie8,
  11. Nick Hooton1,
  12. Sophie Witter4
  1. 1Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
  3. 3Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
  4. 4Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
  5. 5Department of Health Policy, Planning and Management at the School of Public Health, Makerere University, Kampala, Uganda
  6. 6Centre for International Health Policy, Biomedical Research and Training Institute, Harare, Zimbabwe
  7. 7Independent Consultant, Phnom Penh, Cambodia
  8. 8Department of Biochemistry, College of Medicine and Applied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
  1. Correspondence to Tim Martineau; Tim.Martineau{at}


Conflict and fragility are increasing in many areas of the world. This context has been referred to as the ‘new normal’ and affects a billion people. Fragile and conflict-affected states have the worst health indicators and the weakest health systems. This presents a major challenge to achieving universal health coverage. The evidence base for strengthening health systems in these contexts is very weak and hampered by limited research capacity, challenges relating to insecurity and apparent low prioritisation of this area of research by funders. This article reports on findings from a multicountry consortium examining health systems rebuilding post conflict/crisis in Sierra Leone, Zimbabwe, northern Uganda and Cambodia. Across the ReBUILD consortium's interdisciplinary research programme, three cross-cutting themes have emerged through our analytic process: communities, human resources for health and institutions. Understanding the impact of conflict/crisis on the intersecting inequalities faced by households and communities is essential for developing responsive health policies. Health workers demonstrate resilience in conflict/crisis, yet need to be supported post conflict/crisis with appropriate policies related to deployment and incentives that ensure a fair balance across sectors and geographical distribution. Postconflict/crisis contexts are characterised by an influx of multiple players and efforts to support coordination and build strong responsive national and local institutions are critical. The ReBUILD evidence base is starting to fill important knowledge gaps, but further research is needed to support policy makers and practitioners to develop sustainable health systems, without which disadvantaged communities in postconflict and postcrisis contexts will be left behind in efforts to promote universal health coverage.

  • health systems
  • health economics
  • human resources for health
  • health policy
  • gender

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  • Contributors All contributors are authors of ReBUILD research papers and reports cited in this paper. TM and ST produced the first draft of the paper. All authors have contributed to, read and approved the final version of the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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