Delivering UHC in conflict-affected settings

More than 1.6 billion people, or 22% of the global population, live in fragile settings.

Globally, conflict-affected places have the highest mortality rates and the greatest health security risks such as outbreaks of infectious diseases, explained Dr. Margaret Bourdeaux, who focuses her research on health systems and institutions in conflict-affected states at the Harvard Kennedy School.

There is no platform for care delivery, she added, “because you are lacking, or have usually hollowed out and destroyed, even de facto, your health governance.” This is the ability of an empowered group of authorities that have the legitimacy to set priorities, mobilize, and disperse financing, set basic policy about how the sector will be organized, and have regulatory authority.

Dr. Margaret Bourdeaux explains why Afghanistan is such an important case in terms of health system strengthening in conflict-affected states.

In addition, the services offered in a conflict-affected country are often based on the priorities and interests of donors, rather than driven by community participation and needs, she said.

Bourdeaux noted that Afghanistan is a slightly different, and important, case as it has managed to maintain regulatory authority over its health sector. That’s really what went right in Afghanistan, she said.

However, ongoing conflict and a combination of lack of funds, basic health services, and equipment means the health sector continues to be stretched thin — in 2019, an estimated 1.9 million people will be in need of emergency health services alone.

In rural parts of south and east Afghanistan where the security situation is particularly poor, such as Uruzgan province, Cordaid works with local NGOs to deliver national health packages.