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Centre for Health Systems in Fragile and Conflict Affected Settings

The Centre for Health Systems in Fragile and Conflict Affected Settings brings together the interdisciplinary work of over 50 experts at KIT Royal Tropical Institute in the area of global health. We aim to empower people, strengthen health systems and improve universal access to quality healthcare in fragile settings. 

Our team offers methods that account for the contextual complexity of fragile settings: starting from an in-depth understanding of the root causes of the challenges we focus on strengthening domestic or local institutions and actors that can drive change. Our work is unique in that it spans from applied research, monitoring, evaluation and learning (MEL) to technical assistance, capacity development and training.

Approximately a quarter of the world’s population live in fragile settings: countries or territories affected by violence, major economic instability, and precarious governance, unable or unwilling to ensure basic goods and services for (part of) its population. As a result, these settings are particularly vulnerable to acute shocks, such as natural disasters or disease outbreaks. Nearly eighty percent of all people in extreme poverty live in fragile settings, and those living in these settings have, on average, poorer health outcomes. In other words, globally, poor health is increasingly concentrated in fragile settings. 

Improving health outcomes in fragile settings means not just improving service delivery but also durably strengthening the institutions and systems in which these services are embedded, strengthening citizen’s rights and enhancing the responsiveness and inclusiveness of governments. On this webpage you can find an overview of our work, links to our current and former projects on diverse themes of health and development in fragile settings, a broad range of resources and dissemination materials, and an introduction to our team. 

Methods

Our interdisciplinary team employs qualitative, quantitative, and mixed methods in their research, MEL and advisory work, with particular emphasis on politically sensitive, participatory and human-centred design approaches. We offer two specialized courses equipping global health professionals with the skills and methods to analyse and strengthen disrupted health systems in fragile and conflict-affected environments, and a range of tailor-made training programmes for policymakers and implementers in specific fragile settings. Finally, we leverage our role in international consortia to strengthen national health institutions, acting as the lynchpin between domestic and international actors. With this array of methods and approaches we deliver high quality services that inform decision makers and equip them for policy change, the advancement of rights and the strengthening of health systems. 

Contact us

Do you have a question or want to know more? Contact us by sending an e-mail.

Track Record

  • Health Pooled Fund

    • Institute
    • Project

    South Sudan has experienced significant levels of fragility, conflict and violence for nearly half a century. It is estimated that over 400,000 lives have been lost since 2013 due to conflict and millions more have been displaced. With limited access to basic health services, it has some of the worst health indicators in the world, […]

  • Afghan Health: Monitoring and Evaluation

    • Institute
    • Project

    The Afghan Ministry of Public Health requested a third party monitoring & evaluation of its national health services. It was assigned to KIT Royal Tropical Institute by means of a health facility functionality assessment, drug quality assessment, health management information system verification, household surveys and results-based financing assessment. As of 2003, Afghanistan established a novel […]

  • Improving Health Worker’s Performance in Liberia

    • Institute
    • Project

    Problems and challenges At the moment of the Ebola outbreak in 2014, Liberia’s health system was weakened and vulnerable from the civil war, which decimated the nation’s health system. This has led to great brain drain of (potential) health professionals migrating overseas or not returning after completing their health profession degree overseas. Consequently Liberia is […]

  • Results-Based Financing for Maternal Health in Mali

    • Institute
    • Project

    At the request of the Malian Ministry of Health (MoH), KIT undertook action-research in order to develop a model for results-based financing (RBF) in the Koulikoro Region of Mali. Better financing to reduce maternal mortality Across Africa all avenues are being explored in order to achieve the most problematic of the ten Millennium Development Goals (MDG): […]

  • Addressing Governance, Gender and Disasters in a Fragile Health System

    • Institute
    • Project

    This two-week tailor-made training  course was designed to provide staff at the Aga Khan University, Karachi (AKU) with both theory and practical tools for governance and gender mainstreaming within health systems, particularly with respect emergency response. Redressing the balance in an ill-prepared health system Pakistan is regularly confronted with natural disasters as well as conflict. As gender inequality […]

  • South Sudan Health Action and Research Project (SHARP)

    • Institute
    • Project

    KIT assisted the implementation of the three-year South Sudan Health Action and Research Project (SHARP). Working closely with South Sudan’s Ministry of Health, the project aimed to improve the accessibility of reproductive health (RH) care in post-conflict South Sudan. Rebuilding and Envisioning  South Sudan had the highest maternal mortality rate in the world at 2,054 women […]

  • STRENGTHS Project: Scaling Up Psychological Interventions with Syrian Refugees

    • Institute
    • Project

    Millions of Syrian refugees have been affected psychologically by the Syrian conflict. The STRENGTHS project is training Syrian refugees to provide a mental-health intervention called Problem Management+ (PM+) to fellow refugees. Its aim is to help alleviate some of the psychological trauma suffered by those who have escaped the conflict, but paid a high psychological […]

  • Helping Rohingya Refugees in Bangladesh

    • Institute
    • Project

    In 2018, KIT Royal Tropical Institute conducted two assignments to improve health services for refugees and host communities in Cox’s Bazar, Bangladesh. Supporting an over-stretched health system in Cox’s Bazar Since violence erupted in Rakhine State, Myanmar, in August 2017, over 900,000 Rohingya have fled from Myanmar to Bangladesh. These refugees live in makeshift settlements […]

  • FORCE (Formation Santé et Droits Sexuels et Reproductifs) – Mali

    • Institute
    • Project

    Formation Santé et Droits Sexuels et Reproductifs : une collaboration de l’Enseignement Public et Privé pour l’intégration de Ia santé reproductive des adolescents et jeunes dans le curriculum de base des techniciens de santé et techniciens supérieurs de santé. Au Mali, spécifiquement à Mopti et Sikasso, les jeunes et les adolescents éprouvent des difficultés à […]

  • Psychological First Aid: A Crash Course

    • Institute
    • Project

    The Netherlands Red Cross, Light for the World, the IFRC Psychosocial Centre, and KIT Institute are piloting a new crash course to encourage others to use psychological first aid (PFA) in crisis settings. Through scenario-based role play, the course teaches mental health professionals and trained lay people to put PFA into practice and gain valuable […]

  • Sexual Violence in Humanitarian Settings: Nigeria, Yemen and Haiti

    • Institute
    • Project

    This project aims to increase the ability of humanitarian actors to identify and respond to the needs and rights of victims of sexual violence. It also aims to improve the availability of services for sexual violence survivors. The study will generate evidence, identify good practices and disseminate lessons learnt about sexual violence in six different […]

  • Assessment of implementation and outputs of Afghanistan’s Expanded Program of Immunisations data quality improvement plan

    • Institute
    • Project

    Vaccines have substantially reduced or eliminated many infectious diseases which once killed millions of people. Vaccination programmes not only provide vaccines, but strategic leadership and coordination, cold-chain systems necessary for transport, and programme monitoring and evaluation. Behind every vaccination programme, strong health systems are needed to deliver and scale-up new vaccines and to improve immunisation […]

  • Cash and Voucher Assistance for Sexual and Reproductive Health and Rights in Humanitarian Settings and Fragile States

    • Institute
    • Project

    Cash and voucher assistance (CVA) refers to programs where cash or vouchers, exchangeable for goods or services, are directly provided to community members. CVA can help improve access to and the utilisation of health services, by reducing direct and indirect financial barriers and incentivising the use of free preventive services. There is also a growing […]

  • Agribusiness Investments in Fragile States: Research with CASA

    • Institute
    • Project

     Can agribusiness investments in fragile and conflict-affected states deliver commercial returns for investors as well as positive development impact? Together with the Commercial Agriculture for Smallholders and Agribusiness (CASA) Programme, KIT is working to find out.   Stimulating private investment in agribusiness in fragile states KIT conducted the research for an audience of international investors, to show both what is known and what […]

Highlighted Publications

  • The political economy of priority-setting for health in South Sudan: a case study of the health pooled fund

    • Institute
    • Publication

    In fragile and conflict-affected settings (FCAS) such as South Sudan, where health needs are immense, resources are scarce, health infrastructure is rudimentary or damaged, and government stewardship is weak, adequate health intervention priority-setting is especially important. There is a scarcity of research examining priority-setting in FCAS and the related political economy. Yet, capturing these dynamics […]

  • An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan

    • Institute
    • Publication

    Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the […]

  • An assessment of the quality of care provided at primary health care centres in camps for internally displaced persons in Iraq in 2018

    • Institute
    • Publication

    The humanitarian crisis in Iraq remains one of the largest and most unstable in the world. In 2014, over 2.5 million civilians were displaced in Iraq; between 2015 and 2017 more than 3 million people continued to be displaced. While health-related research concerning internally displaced persons (IDPs) population has been conducted in many settings, very few have looked […]

  • Key lessons from a mixed-method evaluation of a postnatal home visit programme in the humanitarian setting of Gaza

    • Institute
    • Publication

    The World Health Organization recommends postnatal home visits to improve maternal and newborn health, but there is limited evidence on the effectiveness of postnatal home visits effectiveness in humanitarian settings. This paper evaluates postnatal home visits implemented in the constrained humanitarian context of Gaza.

  • Estimating maternal mortality: what have we learned from 16 years of surveys in Afghanistan?

    • Institute
    • Publication

    This article contextualises experience within the history of previous efforts to measure maternal mortality in Afghanistan, reviews lessons learnt and reflects on their implications. ‘Particularly hard hit by Afghanistan’s 23 years of war, civil strife and Taliban misrule are Afghan women, who are experiencing what health officials call ”catastrophic”death rates associated with pregnancy and childbirth’. […]

  • Performance-Based Financing, Basic Packages of Health Services and User-Fee Exemption Mechanisms

    • Institute
    • Publication

    An Analysis of Health-Financing Policy Integration in Three Fragile and Conflict-Affected Settings As performance-based financing (PBF) is increasingly implemented across sub-Saharan Africa, some authors have suggested that it could be a ‘stepping stone’ for health-system strengthening and broad health-financing reforms. However, so far, few studies have looked at whether and how PBF is aligned to […]

  • Performance-based financing in three humanitarian settings: principles and pragmatism

    • Institute
    • Publication

    Performance based financing (PBF) has been increasingly implemented across low and middleincome countries, including in fragile and humanitarian settings, which present specific features likely to require adaptation and to influence implementation of any health financing programme. However, the literature has been surprisingly thin in the discussion of how PBF has been adapted to different contexts, […]

  • Research for Change: Assessing Responses to the Needs of Survivors of Sexual Violence in Humanitarian Settings

    • Institute
    • Publication

    Findings from Aden, Lahj, Yemen Sexual and Gender Based Violence (SGBV) is one of the greatest protection, human rights and public health challenges that is present in all societies and is further exacerbated during humanitarian emergencies. In Yemen a nine-year-long conflict has prompted one of the largest humanitarian crises in the world. More than 23.4 […]

  • Lessons Learned: Assessing Responses to the Needs of Survivors of Sexual Violence in Humanitarian Settings

    • Institute
    • Publication

    The research for change project is a research project focusing on assessing sexual violence responses in the context of disaster-prone and conflict areas. The project was executed by KIT Royal Tropical Institute (KIT) and Save the Children. The studies were initially planned in three different countries: Haiti, South Yemen and Northeast Nigeria. The project started […]

  • Assessing Responses to the Needs of Survivors of Sexual Violence in Humanitarian Settings

    • Institute
    • Publication

    Findings from Borno State, Nigeria Almost thirteen years have passed since the conflict in northeast Nigeria erupted into violence, killing 41,596 people,1 displacing 1.7 million, contributing to 5.1 million at risk of being critically food insecure, and putting 8.7 million in need of urgent assistance.2 The conflict has had significant gendered effects, including in terms […]

Specialised Short Courses

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