Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?

INTRODUCTION

Gender in conflict settings

Armed conflict disproportionately affects the morbidity, mortality, and well-being of women, newborns, children, and adolescents. This study presents insights from case studies aiming to assess the provision of sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition interventions in ten conflict-affected settings (Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, and Yemen). Despite the numerous challenges identified, the humanitarian system has proven to be creative and has developed new solutions to bring lifesaving WCH services closer to populations.

Donor priorities driving implementation

Overall, many lifesaving women’s and children’s health (WCH) services for key populations in conflict settings are not delivered everywhere, and priority predefined packages of services are not commonly agreed on or implemented. Donor priorities are the main drivers influencing the ‘what, where, and how’ of implementing interventions. Additionally, working within the political and governance systems in conflict settings is increasingly challenging compared to previous decades, given the dynamic nature of modern conflict and the expanding role of non-state armed groups.

KEY TAKEAWAYS

1. Best Practices to Improve Governance, Leadership, and Coordination

   To improve governance, leadership, and coordination, best practices included political analysis on power balance between the various warring parties and the various humanitarian actors and decentralisation of operations by contracting local organisations.

2. Best Practices to Improve Health Financing for Emergencies

   To improve health financing for emergencies, multi-year funding mechanisms and emergency pooled funds were created.

3. Best Practices to Strengthen the Health Workforce

   To strengthen the health workforce, best practices included task shifting and task sharing, rotation of senior staff to remote areas, and hiring local staff to nurture trust with local communities.

4. Developing Supply Information Systems

   Electronic stock management and supply information systems were developed to automate the identification of shortage and need for resupply of essential medicines and supplies.

5. Improving Health Service Delivery

   Health service delivery was improved by using mobile clinics in remote areas, recruiting lay workers who have good knowledge of their community, promoting community-based services, and providing integrated packages of services at the point of care.

6. Addressing Insecurity

   Insecurity was addressed by training health staff on security measures, utilising remote management, using security intelligence to inform staff movement, and holding contextually driven negotiations with non-state armed groups to gain access to populations and protect populations and health staff.

7. Using Social Research

   Social research was used to understand community dynamics and sociocultural factors and to inform the delivery of humanitarian programs.

The humanitarian system is creative and pluralistic and has developed some novel solutions to bring lifesaving WCH services closer to populations using new modes of delivery. These solutions, when rigorously evaluated, can represent concrete response to current implementation challenges to modern armed conflicts.

Access Journal Article.