Sharing knowhow and joining forces towards Health for All

Health systems strengthening and conflict transformation in fragile states

Health systems strengthening and conflict transformation in fragile states

Amsterdam, 11 October 2012. Medicus Mundi International Network expert meeting hosted by Cordaid at the Royal Tropical Institute (KIT)

Strengthening health systems in fragile states is often challenging given the limited resources available, problems of governance, and the difficulties of organising and delivering health care. Despite these challenges, there has been increasing focus on strengthening health systems as fragile states have a high burden of ill health, and are currently off-track to meet the health millennium development goals.  

In addition, many feel that health activities and health system strengthening might play a role in conflict transformation; which is generally aimed at the root causes of conflict over the long term and addresses the structural, behavioural and attitudinal aspects of conflict. This could be at the community level, but also at national or sub-national levels, e.g. by strengthening governance for health or improving legitimacy of authorities.  What is the evidence based for this, and what are the experiences at these different levels?

The objective of this expert meeting attended by over 80 participants was to facilitate learning and information sharing on health sector initiatives that aim to improve health outcomes, contribute to longer term, sustainable health system strengthening and conflict transformation, in order to inform programming, policy, advocacy and further research.

Meeting documentation

Meeting report

  • Prepared by Egbert Sondorp and Selma Scheewe, Royal Tropical Institute
    > PDF


Setting the scene

  • Health systems strengthening and conflict transformation
    Egbert Sondorp, Senior Health Advisor, KIT Amsterdam
    > Introductory remarks: PPT as PDF
    > Editorial in MMI Network news, September 2012
  • (How) can delivering basic services lead to conflict transformation?
    Rachel Slater, ODI; Research Director Secure Livelihoods Research Consortium
    > Keynote: PPT as PDF
    > SLRC leaflet as  PDF
    > Social protection and basic services in fragile and conflict-affected situations: findings from a global review. Samuel Carpenter, Richard Mallett and Rachel Slater, Draft SLRC Briefing Paper, October 2012: paper as PDF


Pecha Kucha session
  • Is there a link between health system research and conflict resolution? …the ReBUILD experience
    Suzanne Fustukian, Queen Margaret University
    > PPT as PDF
  • International actors and political determinants of conflict and health.
    Remco van de Pas, Wemos
    > PPT as PDF
    > Paper as PDF
  • Health Systems in (Post-) Conflict Situations, Transitional Justice and Peacebuilding
    Sylvia Servaes, FriEnt/Misereor
    > PPT as PDF
    > Article as PDF: Linking peacebuilding and health in post-conflict settings. Laplante 2011 
  • Health systems evidence and guidance in fragile states
    Xavier Bosch-Capblanch, Swiss Centre for International Health / Swiss Tropical and Public Health Institute, and Claire Allen, EvidenceAid (Cochrane Collaboration)
    > PPT as PDF
  • Mental Health & Psychosocial interventions are essential in conflict transformation
    Willem van de Put, HealthNetTPO
    > PPT as PDF


Case studies:
National health systems

  • The role of better pay and active staff management to deliver and sustain free health care in Sierra Leone
    Charlie Goldsmith Associates, Erin Chu
    > PPT as PDF
    > Paper as PDF
  • A co-oordinated township approach to health service delivery – using opportunities to support the health system in Myanmar in the aftermath of Cyclone Nargis
    Merlin, Paul Sender
    > PPT as PDF
    > Paper as PDF
  • Strengthening the policy implementation gap – federal working relationships in the Nigerian health sector
    Health Partners International, Andrew McKenzie
    > PPT as PDF
    > Papers: PDFa and PDFb

Case studies:
Performance based financing

  • Contribution du programme de financement  basé sur la performance au renforcement du système de santé dans un contexte de conflit (RDC)
    AAP Sud Kivu, Pacifique Mushagalusa
    > PPT as PDF
    > Paper as PDF
  • Applying an institutional economic framework to the analysis of two performance based finance schemes in Burundi
    ITM Antwerp, Bruno Meessen
    > PPT as PDF
    > Paper as PDF
  • Renforcement de l'autorité de l'état basé sur l'achat de performances dans un contexte de conflit
    Cordaid, Michel Zabiti
    > PPT as PDF
    > Paper as PDF
  • Le financement basé sur la performance et la bonne gouvernance: Leçons apprises en République Centrafricaine
    Cordaid, Peter Bob Peerenboom and Dr. Malam Issa Inoussa
    > PPT as PDF
    > Paper as PDF


Case studies:
Community and district level interventions

  • Uruzgan: basic health care and conflict transformation (Afghanistan)
    Cordaid-Kabul, Jain Holsheimer
    > Paper as PDF
  • Case study Tajikistan
    SwissTPH, Joao Costa
    > Paper as PDF
  • Health system strengthening in district Battagram, Pakistan (2008-2011)
    Save the Children, Zaeem Ul Haq
    > PPT as PDF
    > Paper as PDF
  • Health system strengthening and conflict transformation in fragile states: Memisa’s flexible approach to a changing context in Ituri, DRC
    Memisa, Elies van Belle
    > PPT as PDF
    > Paper as PDF


Other contributions

  • Strengthening top-down and bottom-up accountability: the view from Aceh, Indonesia
    Broad Branch Associates, Lindsay Morgan
    >  Paper as PDF
  • Building Back Better? Health System Reconstruction and Gender Equity
    Val Percival, NPSIA/Carleton University; Tammy Maclean, LSHTM; Esther Richards, REBUILD, LSTM; Sally Theobald, REBUILD, LSTM; Justine Namakula, REBUILD, Makerere University; Sarah Ssali, REBUILD, Makerere University; Francelina Romão, Mozambique Ministry of Health; Joseph Edem-Hotah, REBUILD, College of Medicine and Allied Health Sciences.
    > Poster as PDF
    > Paper as PDF
  • Nation building and community based health service delivery, Timor Leste
    USAID, Tanya Wells Brown
    > Paper as PDF
  • Building a national HIMS in South Sudan: Investing in Systems
    Health Information Systems Programme and Liverpool School of Tropical Medicine, Mo Ali & Carmen Camino
    > Paper as PDF

Looking back to the meeting



  • Christina de Vries and Jennie van de Weerd, Cordaid
  • Egbert Sondorp, Selma Scheewe and Ankie van den Broek, Royal Tropical Institute
  • Godelieve van Heteren, Rotterdam Global Health Initiative

Involved Medicus Mundi International Network members: Nick Lorenz (President), Guus Eskens (Board member), Remco van de Pas (Wemos), Willem van de Put (HealthNet TPO) and Thomas Schwarz (Secretariat), and Cordaid representatives.

For feedback and enquiries about the meting please get in touch with:
Selma Scheewe, Advisor, KIT Development Policy & Practice
+31 (0)20 568 8593,


Other MMI Network events in Amsterdam

  • Getting evidence into NGO practice and policy
    MMI research workshop in Amsterdam, 10 October 2012
    See separate page
  • MMI Assembly and Board meeting
    Amsterdam, 10 October 2012
    See separate page

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