Health financing in fragile and conflict-affected settings: What do we know, seven years on?


Over the last few years, there has been growing attention to health systems research in fragile and conflict-affected setting (FCAS) from both researchers and donors. In 2012, an exploratory literature review was conducted to analyse the main themes and findings of recent literature focusing on health financing in FCAS. Seven years later, this paper presents an update of that review, reflecting on what has changed in terms of the knowledge base, and what are the on-going gaps and new challenges in our understanding of health financing in FCAS.


Bibliometric analysis of 115 documents suggests that the field has continued to grow, and is skewed towards countries with a large donor presence (such as Afghanistan). Aid coordination remains the largest single topic within the themes, likely reflecting the dominance of external players, not just substantively but also in relation to research. Many studies are commissioned by external agencies and in addition to concerns about independence of findings there is also likely a neglect of smaller, more home-grown reforms. In addition, we find that despite efforts to coordinate approaches across humanitarian and developmental settings, the literature remains distinct between them.

We highlight research gaps, including empirical analysis of domestic and external financing trends across FCAS and non-FCAS over time, to understand better common health financing trajectories, what drives them and their implications. We highlight a dearth of evidence in relation to health financing goals and objectives for UHC (such as equity, efficiency, financial access), which is significant given the relevance of UHC, and the importance of the social and political values which different health financing arrangements can communicate, which also merit in-depth study.

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Bertone M1, Jowett M2, Dale E2, Witter S1, Health financing in fragile and conflict-affected settings: What do we know, seven years on?, Social Science & Medicine (2019),

1. ReBUILD & Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK

2. Health Financing Unit, World Health Organisation, Geneva, Switzerland

This resource was produced by the ReBUILD programme – the precursor of ReBUILD for Resilience.