Journal Article
24 Jan 2021
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Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?

The Lancet Neha S Singh, PhD Anushka Ataullahjan, PhD Khadidiatou Ndiay...+17 more
The Lancet
Neha S Singh, PhD Anushka Ataullahjan, PhD Khadidiatou Ndiaye, PhD Jai K Das, MB Prof Paul H Wise, MD Chiara Altare, PhD Zahra Ahmed, MSc Samira Sami, PhD Chaza Akik, DrPH Hannah Tappis, DrPH Shafiq Mirzazada, MPH Prof Isabel C Garcés-Palacio, DrPH Hala Ghattas, PhD Prof Ana Langer, MD Prof Ronald J Waldman, MD Prof Paul Spiegel, PhD Prof Zulfiqar A Bhutta, PhD Prof Karl Blanchet, PhD BRANCH Consortium Steering Committee
African Region
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What you'll learn
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.
What works and doesn't work?
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.
A group of kids sitting in an open window in Sierra Leone.
Key Takeaways
1
Best practices to improve governance, leadership, and coordination
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
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 work force
Best practices to strengthen the health work force
To strengthen the health work force, best practices included ask 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
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
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
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
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.

Afilliations
  1. Neha S Singh, PhD, Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
  2. Anushka Ataullahjan, PhD, Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
  3. Khadidiatou Ndiaye, PhD, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
  4. Jai K Das, MB, Centre of Excellence in Women and Child Health and Institute of Global Health and Development, The Aga Khan University, Karachi, Pakistan
  5. Prof Paul H Wise, MD, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
  6. Chiara Altare, PhD, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
  7. Zahra Ahmed, MSc, Somali Disaster Resilience Institute, Mogadishu, Somalia
  8. Samira Sami, PhD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
  9. Chaza Akik, DrPH, Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  10. Hannah Tappis, DrPH, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  11. Shafiq Mirzazada, MPH, Aga Khan University, Kabul, Afghanistan
  12. Prof Isabel C Garcés-Palacio, DrPH, Epidemiology group, School of Public Health, Universidad de Antioquia, Medellín, Colombia
  13. Hala Ghattas, PhD, Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  14. Prof Ana Langer, MD, Women and Health Initiative, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
  15. Prof Ronald J Waldman, MD, Global Health Department, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Doctors of the World, New York, NY, USA
  16. Prof Paul Spiegel, PhD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  17. Prof Zulfiqar A Bhutta, PhD, Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Centre of Excellence in Women and Child Health and Institute of Global Health and Development, The Aga Khan University, Karachi, Pakistan
  18. Prof Karl Blanchet, PhD Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK; The Geneva Centre of Humanitarian Studies, University of Geneva, Graduate Institute, Geneva 1211, Switzerland
  19. BRANCH Consortium Steering Committee: Members include Zulfiqar Bhutta, Robert Black, Karl Blanchet, Ties Boerma, Michelle Gaffey, Ana Langer, Paul Spiegel, Ronald Waldman, and Paul Wise
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