Health system strengthening in fragile and conflict-affected states: A review of systematic reviews

作者：Birke Bogale, Sasha Scambler, Aina Najwa Mohd Khairuddin, Jennifer Elizabeth Gallagher · 发表于：PLoS ONE · 年份：2024 · DOI：10.1371/journal.pone.0305234 · 被引用次数：118 · 研究领域：Global Maternal and Child Health、Global Health and Surgery、Viral Infections and Outbreaks Research

BACKGROUND: Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature. METHODS: We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet's 'high-quality health system framework'. RESULTS: Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the 'foundations' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the contex...