Developing Equitable Primary Health Care in Conflict-Affected Settings: Expert Perspectives From the Frontlines

Abstract

Health systems are frequently among the casualties of conflict. Within these settings, increased knowledge is needed on how to rebuild and strengthen health infrastructure resilience, such as primary health care (PHC) systems, in context-specific ways that promote health equity. Therefore, this study aimed to explore perspectives of experts with experience working on frontlines of social crises to contribute to understandings of pathways toward equitable PHC in conflict-affected settings. Semistructured qualitative interviews with 18 expert participants were completed. Through engaging elements of grounded theory situational analysis, three themes emerged iteratively, including (a) Building Blocks, (b) Intermediating Factors, and (c) a Roadmap. These emergent themes contribute to conceptual frameworks explaining key contextually specific priorities, challenges, and facilitating factors for developing resilient health infrastructures under social crises. Findings inform policy and practical guidelines that address complexities of conflict conditions and underscore the importance of PHC development toward promoting health as a human right.

Health-related quality of life of a conflict-affected population in Colombia

“…Armed conflicts have profound adverse effects on people's health [1]. These effects usually last for long periods in the aftermath of armed conflicts, also due to the destruction of health-supporting infrastructure [2]. This is particularly the case in countries beset by protracted civil confrontations, which have become the norm in recent decades [3].…”

“…(1) To assess the validity of EQ-5D in a conflict-affected population; (2) To explore the correlations between conflict intensity levels in the area of residence of individuals and their HRQoL, using longitudinal individual-level data referring to periods before and after the peace accord in Colombia; (3) To identify factors associated with HRQoL among conflict-affected individuals in Colombia.…”

Harnessing instability as an opportunity for health system strengthening: A review of health system resilience

“…Resilience-building efforts also require community engagement in order to guide the elaboration of acceptable and effective interventions that are aligned with national priorities and responsive to current and future local needs. 17,52,53,56,66,[74][75][76][77][78][79] Furthermore, community engagement can foster social cohesion and enable health systems to address the broader social determinants of health that can increase vulnerability and impede adaptability at the micro-level. 6,15,32,33,50,53,80,81 Health systems that provide universal access to integrative care addressing a diverse range of health needs increase the frequency of their interactions with the public, which serve as opportunities to build trust, promote care-seeking behaviour, and enable rapid detection of emerging needs and health threats.…”

“…6,[12][13][14][15][16] A complex adaptive systems perspective would lead us to move beyond an understanding of resilience as the system's capacity to withstand instability and return to its stable state and acknowledge agents' ability to adapt, learn, and transform a system to achieve more innovative and desirable configurations. 2,7,17,18 In line with this perspective, Kruk et al define health system resilience as "the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, informed by lessons learned during the crisis, reorganize if conditions require it." 6 To inform resilience-building efforts, the underlying mechanisms in the activation of resilience must be understood.…”

After the Astana declaration: is comprehensive primary health care set for success this time?

“…Insecurity, conflicts and disease outbreaks are threatening health care around the world 29. In particular, structures of PHC such as community health centres and small hospitals are often the most vulnerable to violence, conflict and war 30. In other areas, particular diseases (eg, malaria) or outbreaks (eg, Ebola) lead to a disproportional disease burden destabilising the existing PHC structures.…”