Networked health sector governance and state-building legitimacy in conflict-affected fragile states : the variable impact of non-state provision of public health services in eastern Democratic Republic of Congo

Aembe, Bwimana

doi:10.18174/411653

Cited by 1 publication

(3 citation statements)

References 97 publications

(108 reference statements)

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“…Douedari & Howard additionally emphasised the need for caution in translating some health system terms from English, as, for example, accountability in Arabic could mean investigation and lack of trust, while legitimacy could have religious connotations [22]. Aembe et al mentioned the importance of analysing both verbal and paralinguistic (e.g., non-verbal) elements of communication, thus highlighting the importance of 'localism' of lead researchers who can speak indigenous languages and understand local context and nuance when interpreting and writing up findings [2].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the general lack of theory, over half of sources used qualitative single or multimethod study designs. A good example was Aembe et al 's qualitative multimethod study, which used ethnography and storytelling to examine how health system governance in DRC was characterised by multi-stakeholder engagement and how this de facto networked governance contributed to state formation in this fragile context [2]. However, reliance on qualitative research for most evaluations, which was generally exploratory in nature and only sampled limited numbers and types of participants, makes it difficult to transfer findings and interpretations more broadly, e.g., to other conflict-affected settings [39].…”

Section: Dominance Of Qualitative Approaches and Methodsmentioning

confidence: 99%

“…Most sources used qualitative study designs (31/58; 53%), while (16/58; 28%) were quantitative and (11/58; 19%) used mixed methods. Among 31 qualitative sources, most (28/58; 48%) used semi-structured or in-depth interviews, followed by 7 using focus group discussions [9,17,25,36], 1 using storytelling [28], and 1 combining storytelling and ethnography [2]. Of 17 quantitative sources, 12 conducted cross-sectional surveys, 3 (38%) conducted secondary analyses of survey and hospital record data [27,45,49], 1 (13%) conducted a cohort study [60], and 1 (13%) conducted an impact evaluation used the TB REACH monitoring and evaluation framework.…”

Section: Naturementioning

confidence: 99%

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Health system evaluation in conflict-affected countries: a scoping review of approaches and methods

et al. 2023

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Introduction Strengthening health systems in conflict-affected settings has become increasingly professionalised. However, evaluation remains challenging and often insufficiently documented in the literature. Many, particularly small-scale health system evaluations, are conducted by government bodies or non-governmental organisations (NGO) with limited capacity to publish their experiences. It is essential to identify the existing literature and main findings as a baseline for future efforts to evaluate the capacity and resilience of conflict-affected health systems. We thus aimed to synthesise the scope of methodological approaches and methods used in the peer-reviewed literature on health system evaluation in conflict-affected settings. Methods We conducted a scoping review using Arksey and O’Malley’s method and synthesised findings using the WHO health system ‘building blocks’ framework. Results We included 58 eligible sources of 2,355 screened, which included examination of health systems or components in 26 conflict-affected countries, primarily South Sudan and Afghanistan (7 sources each), Democratic Republic of the Congo (6), and Palestine (5). Most sources (86%) were led by foreign academic institutes and international donors and focused on health services delivery (78%), with qualitative designs predominating (53%). Theoretical or conceptual grounding was extremely limited and study designs were not generally complex, as many sources (43%) were NGO project evaluations for international donors and relied on simple and lower-cost methods. Sources were also limited in terms of geography (e.g., limited coverage of the Americas region), by component (e.g., preferences for specific components such as service delivery), gendered (e.g., limited participation of women), and colonised (e.g., limited authorship and research leadership from affected countries). Conclusion The evaluation literature in conflict-affected settings remains limited in scope and content, favouring simplified study designs and methods, and including those components and projects implemented or funded internationally. Many identified challenges and limitations (e.g., limited innovation/contextualisation, poor engagement with local actors, gender and language biases) could be mitigated with more rigorous and systematic evaluation approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Dominance Of Qualitative Approaches and Methodsmentioning

confidence: 99%