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Health Research Policy and Systems

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Open Access 01-12-2017 | Research

Health systems research in fragile and conflict affected states: a qualitative study of associated challenges

Authors: Aniek Woodward, Kate Sheahan, Tim Martineau, Egbert Sondorp

Published in: Health Research Policy and Systems | Issue 1/2017

Abstract

Background

High quality health systems research (HSR) in fragile and conflict-affected states (FCAS) is essential to guiding the policies and programmes that will improve access to health services and, ultimately, health outcomes. Yet, conducting HSR in FCAS is challenging. An understanding of these challenges is essential to tackling them and to supporting research conducted in these complex environments. Led by the Thematic Working Group on Health Systems in FCAS, the primary aim of this study was to develop a research agenda on HSR in FCAS. The secondary aim was to identify the challenges associated with conducting HSR in these contexts. This paper presents these challenges.

Methods

Guided by a purposely-selected steering group, this qualitative study collected respondents’ perspectives through an online survey (n = 61) and a group discussion at the Third Global Symposium on HSR in September 2014 (n = 11). Respondents with knowledge and/or experience of HSR in FCAS were intentionally recruited.

Results

Of those ever involved in HSR in FCAS (45/61, 75%), almost all (98%) experienced challenges in conducting their research. Challenges fall under three broad thematic areas: (1) lack of appropriate support; (2) complex local research environment, including access constraints, weak local research capacity, collaboration challenges and lack of trust in the research process; and (3) limited research application, including rapidly outdated findings and lack of engagement with the research process and results.

Conclusions

This study shows that those familiar with HSR in FCAS face many challenges in gaining support for and in conducting and applying high-quality research. There is a need for more sustainable support, including commitment to and long-term funding of HSR in FCAS; investment in capacity building within FCAS to meet the challenges related to implementation of research in these complex environments; relationship and trust building among stakeholders involved in HSR, particularly between local and international researchers and between researchers and participants; and innovative and flexible approaches to research design and implementation in these insecure and rapidly changing contexts.

Available only for authorised users

The TWG-HS-FCAS is a cooperation between the Health & Fragile States Network and the ReBUILD Consortium. As a working group of Health Systems Global, we aim to strengthen HSR in FCAS. http://healthsystemsglobal.org/twg-group/8/Health-Systems-in-Fragile-and-Conflict-Affected-States/.

Third Global Symposium on HSR, organised by Health Systems Global, took place in Cape Town (2014), building on two previous symposia held in Montreux (2010) and Beijing (2012). http://healthsystemsresearch.org/hsr2014/home?qt-programme_at_a_glance=1.

The Health and Fragile States Network, established in 2007 and consisting of practitioners, researchers and funders, aims to contribute to the evidence base on health and fragile states; to influence policy and advocate collectively on a range of issues which impact on health in fragile states; and to support dialogue, debate and networking amongst those working in health and fragile states, and with those who work in other related sectors.

The ReBUILD Consortium conducts research for stronger health systems post conflict. www.rebuildconsortium.com.

The TWG LinkedIn group brings together key actors on health in FCAS and promotes research, policy and advocacy actions to develop and implement responsive and context-specific health systems. https://www.linkedin.com/groups/6611870.

In cooperation with the TWG, BioMed Central’s journal Conflict and Health published a series of articles entitled ‘Filling the void: Health systems in fragile and conflict affected states’. http://www.conflictandhealth.com/series/Filling_the_void.

This interactive map was developed via ‘Google - Map Data’ and can be accessed here: https://fusiontables.google.com/DataSource?docid=1nFPsjV6slJjg0v0uPaktlypYzPVc-5sYgDWHLpPD#map:id=3.

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Title: Health systems research in fragile and conflict affected states: a qualitative study of associated challenges
Authors: Aniek Woodward
Kate Sheahan
Tim Martineau
Egbert Sondorp
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Health Research Policy and Systems / Issue 1/2017
Electronic ISSN: 1478-4505
DOI: https://doi.org/10.1186/s12961-017-0204-x

At a glance: The STEP trials

Springer Medicine

Health systems research in fragile and conflict affected states: a qualitative study of associated challenges

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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