The House of Commons International Development Committee reported last Friday on the findings of its enquiry into the role of the UK Department for international Development (DFID) in strengthening health systems in developing countries. It recommended that DFID must use its expertise in this area to show global leadership and influence the agendas of its international partners, and build up health systems through strategic linkages with the opportunity of the post-2015 development goals which support universal health coverage.
The DFID-funded ReBUILD Consortium, which is growing the evidence base of how health systems develop in the aftermath of conflict and fragility in low- and middle-income countries, provided written evidence to this committee. We highlighted the importance of the particular needs of these states and the learning that can be applied from understanding how the decisions made after conflict can impact on the longer term development of the health system, including widening access to health care for the poorest populations. We agree with the conclusions of the report that health systems strengthening is essential to tackling the challenges faced including the growing and persistent issue of conflict-affected regions.
Nowhere more, than in the post conflict areas of West Africa devastated by Ebola outbreaks, is the need for strong health infrastructures that can respond quickly to such crises needed. The cases of Sierra Leone and Liberia were both highlighted in the report. The rapid spread of Ebola and the slow response to treat those infected, the disaffection of health workers due to lack of essential materials and protective personal equipment have been indicative of the weakness of the Sierra Leone health system, a country included within the ReBUILD research portfolio.
Our colleague Haja Wurie reports:
“A weak health system and poor governance and complicated bureaucracy delayed the response to the outbreak. Infrastructural challenges, infection control practices, poor water and sanitation, electricity, communication, health promotion and education are weak. The post conflict economy was a challenge for many homes meaning seeking education was not a priority. This resulted in low levels of literacy which in turn translated into slow uptake of the sensitisation exercise about the virus in the early stage of the outbreak in conjunction with the initial denial.”
The breakdown of frontline services has led to other non-Ebola related illnesses now not being treated as the population loses confidence in the health system to treat them. This threatens attempts that have been made in the post-conflict period to establish elements of universal health care through the free health care initiative for pregnant and lactating women and children under age 5.
In taking forward the findings of the report there is a need to
- Understand the importance of health system strengthening as rapidly as possible following conflict and social breakdown in order to ensure resilience in the face of epidemic outbreaks.
- Understand what makes a health system resilient, by looking at successful systems that have successfully contained epidemics in conflict areas such as Northern Uganda.
- Ensure that decisions made post conflict are supportive of developing the sustainability of the health system longer term as well as consolidating universal health care principles
- Ensure the global leadership provided by DFID considers the importance of addressing health systems development in post-conflict countries in particular.
The ReBUILD consortium welcomes the report’s recommendations that DFID increase funding for health system strengthening research. We argue that it is important for resources to be allocated to understanding the needs of the growing number of states and regions that are likely to emerge from conflict in the future.
By Helen Carlin, Liverpool School of Tropical Medicine