Employment based health financing does not support gender equity in universal health coverage

This paper argues that health financing and entitlement systems linked to employment can actually disadvantage women and explores how that happens

ReBUILD cross cutting and synthesis non peer-reviewed outputs

Summary of ReBUILD’s cross cutting and synthesis non peer-reviewed outputs, eg videos, briefs, infographics etc

Health Systems Financing

Health financing policy in fragile & conflict-affected situations

These two papers, produced for the World Health Organization, look at health financing policy in fragile and conflict-affected settings – Health financing policy and implementation in fragile and conflict-affected settings and Health financing policy in fragile & conflict-affected situations

Performance-Based Financing, Basic Packages of Health Services and User-Fee Exemption Mechanisms: An Analysis of Health-Financing Policy Integration in Three Fragile and Conflict-Affected Settings

Research looking at whether and how performance-based financing is integrated with national financing strategies, especially in fragile and conflict-affected settings

Results-based financing as a strategic purchasing intervention: some progress but much further to go in Zimbabwe?

Research which empirically and systematically examines how results-based financing impacts on health care purchasing in Zimbabwe

Evidence review of what works for health systems strengthening, where and when?

Research from ReBUILD and partners on identifying evidence on effective health systems strengthening approaches in different contexts

Health system strengthening – reflections on its meaning, assessment and our state of knowledge

Paper reflecting on undertaking a health systems strengthening review, drawing out suggestions on definitions and approaches to assessment, plus key conclusions

Health system strengthening – what is it, how should we assess it, and does it work?

Presentation (video and slides) given by Professor Sophie Witter on a report on health systems strengthening

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

Paper from ReBUILD looking at literature on health systems financing in fragile and conflict-affected settings and how it has changed in 2012-19

(How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo

Results-Based Financing has proliferated in health sectors of low and middle income countries, especially fragile and conflict-affected ones, and has been presented as a way of reforming and strengthening strategic purchasing. However, few studies have empirically examined how RBF impacts on health care purchasing in these settings. This article examines the effects of several RBF programmes on health care purchasing functions
the past decade.

Les systèmes de santé après un conflit – éléments probants en faveur de meilleures politiques et pratiques

Ces documents de synthèse décrivent les thèmes principaux issus des recherches de ReBUILD, ainsi qu’un aperçu du programme et de son large éventail de projets de recherche jusqu’en 2016.

Videos – performance-based financing presentations from HSR 2018

Three presentations on performance-based financing filmed during the 2018 Fifth Global Symposium on Health Systems Research

A summary of ReBUILD’s research themes, projects and related outputs

A summary document giving an overview of the projects and research themes which have made up ReBUILD’s work.

Resources from ReBUILD’s research on gender in post-conflict health systems

Details of all outputs from ReBUILD’s work on gender and post-conflict health systems.

Video – ‘The bumpy trajectory of performance-based financing for healthcare in Sierra Leone’

Dr Maria Bertone speaks about performance-based financing for healthcare in Sierra Leone

Video on health financing in fragile and conflict-affected states

Professor Sophie Witter speaks about health financing in fragile and conflict-affected states

Video introduction to performance-based financing

Professor Sophie Witter speaks about performance-based financing as a way to build strategic purchasing in fragile and conflict-affected states.

Sustainability of health systems in crisis-affected settings: lessons for practice

This policy brief reviews key dimensions of sustainability and their relevance for crisis-affected settings, then presents lessons for encouraging sustainability in these settings.

How to move towards universal health coverage in crisis-affected settings: lessons from research

This policy brief reviews the meaning of universal health coverage (UHC) and summarises lessons for achieving UHC in crisis-affected settings.

Institutions for strong and equitable health systems after conflict and crisis – lessons from ReBUILD research

This brief outlines the findings from ReBUILD’s phase 1 research informing the theme of institutions in post-conflict health systems.

Health financing policy in conflict affected settings – lessons from ReBUILD research

This brief outlines the findings from ReBUILD’s phase 1 research on health financing policies in post-conflict settings and how these have affected access to health care for the most vulnerable populations.

Les systèmes de santé pendant et après une crise : éléments probants en faveur de meilleures politiques et pratiques

Cette série de documents de synthèse, fruit des recherches menées par ReBUILD, aborde un nombre de questions clés concernant le renforcement des systèmes de santé dans les contextes affectés par un conflit ou une crise.

ReBUILD cross cutting and synthesis non peer-reviewed outputs

Summary of ReBUILD’s cross cutting and synthesis non peer-reviewed outputs, eg videos, briefs, infographics etc

Health systems during and after crisis: evidence for better policy and practice

This series of ReBUILD briefing papers addresses some key questions related to health systems strengthening in settings affected by conflict or crisis.

Webinar – Performance-based financing in fragile and conflict-affected settings: from research to practice

Recording of a webinar on the impact of PBF research on practice in fragile and conflict-affected settings

Performance-based financing as a way to build strategic purchasing in fragile and conflict affected settings: potential and pitfalls

Presentation given by Sophie Witter at a Satellite Session on “Payment for Performance, how, why, where and what?”, at the Fifth Global Symposium on Health Systems Research in Liverpool, on 9th October 2018.

The bumpy trajectory of performance-based financing for healthcare in Sierra Leone

A ReBUILD paper on the development of performance-based financing for healthcare in Sierra Leone

The bumpy trajectory of performance-based financing in Sierra Leone: agency, structure and frames shaping the policy process

Presentation given by Maria Paula Bertone at the 5th Global Symposium on Health Systems Reseach in Liverpool on Wednesday 10th October 2018.

Investigating results-based financing as a tool for strategic purchasing: comparing the cases of the Democratic Republic of Congo, Zimbabwe and Uganda

Presentation given by Maria Paula Bertone at a Satellite session of the 5th Global Symposium on Health Systems Reseach, on “Payment for Performance, how, why, where and what? Learning from research across income settings. Tuesday 9th October 2018.

Health financing in fragile and conflict affected settings

Presentation given by Sophie Witter at a satellite session on “Health financing in fragile & conflict affected settings – controversies and innovations” at the 5th Global Symposium on Health Systems Research in Liverpool, on 8th October 2018.

Performance-based financing video

Video of Maria Bertone of ReBUILD speaking on the consortium’s work on performance-based financing in fragile and post-conflict states

The political economy of results-based financing: the experience of the health system in Zimbabwe

Poster presented at the Fifth Global Symposium on Health Systems Research in Liverpool in October 2018 on the political economy of results-based financing

Summary of ReBUILD’s research themes, projects and outputs 2018

This summary of ReBUILD’s research projects from both the original phase and the short extension phase of the programme. It includes links to further information on the projects and their outputs.

Health Systems in Situations of Fragility

Presentation given by Professor Sophie Witter on 17th May 2018 for the American University of Beirut Global Health Institute’s Webinar series: “Global Health and Conflict”. This webinar theme: Health Systems in Situations of Fragility.

The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts

A paper from ReBUILD exploring the gendered experiences of health workers in fragile and post-conflict states

Changes in catastrophic health expenditure in post-conflict Sierra Leone: an Oaxaca-blinder decomposition analysis

A paper from ReBUILD examining how households’ exposure to financial risks through seeking healthcare evolved in post-conflict Sierra Leone.

Performance-based financing in three humanitarian settings: principles and pragmatism

A paper from ReBUILD’s study exploring how performance-based financing emerged and was adapted in three humanitarian settings.

The human resource implications of improving financial risk protection for mothers and newborns in Zimbabwe

This 2013 paper examines implications for human resources for health of changes in user fees for maternal and newborn health services in Zimbabwe.

Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems

Literature review from ReBUILD by on how context affects performance-based health financing in fragile and conflict-affected settings.

What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal

ReBUILD paper examines health systems research that explored and evaluated health worker performance during crises in Sierra Leone & Nepal

Resilience of health systems during and after crises – what does it mean and how can it be enhanced?

This policy brief summarises different aspects of health system resilience, its measurement, and strategies for enhancing resilience during and after crises.

Resources from ReBUILD’s work on health financing in conflict-affected and post-conflict settings

Health financing in conflict-affected and post-conflict settings: Resources from ReBUILD’s work

The commercialization of traditional medicine in modern Cambodia

This 2017 paper describes the findings from ReBUILD’s research in Cambodia as part of the health financing research strand

Minding the gaps: health financing, universal health coverage and gender

This 2017 ReBUILD paper reflects on why we need to focus on gender when moving towards Universal Health Coverage

Impact of health financing policies in Cambodia: A 20 year experience

This paper reports on some of the findings from ReBUILD’s quantitative research into post-conflict health financing policies in Cambodia.

Health worker experiences of and movement between public and private not-for-profit sectors – findings from post-conflict Northern Uganda

This paper looks at the experiences of health workers during and after the 20 years of conflict in northern Uganda, and the factors that influenced their movement between public and private not-for-profit sectors. The findings highlight the need to ensure balanced health labour market incentives which take into account not only the changing context but also needs at different points in individuals’ life cycles and across all core service delivery sectors.

Impact of user fees on health care seeking behaviour and financial protection during the crisis period in Zimbabwe: A life history approach

This report presents the findings and recommendations from part of ReBUILD’s qualitative health financing research in Zimbabwe, using the life histories approach.

ReBUILDing Health Systems Beyond Health Facilities

This brief is one of two briefs from ReBUILD’s research on health system financing and households’ coping strategies for health care needs in post-conflict northern Uganda.

A strong public health sector key for health system resilience in Gulu district, northern Uganda

First of two briefs from ReBUILD’s research on health system financing and households’ coping strategies for health care needs in post-conflict northern Uganda.

Key messages from ReBUILD research in Uganda

This brief outlines the key messages which have come from ReBUILD’s research on health financing, health workforce and aid effectiveness in post-conflict northern Uganda

Health systems in post conflict Uganda – ReBUILD video

From ReBUILD’s partners at Makerere University School of Public Health – an overview of the context and issues covered by the team’s research on the post-conflict health system in northern Uganda.

Health financing and UHC – what’s gender got to do with it?

Presentation made by Sophie Witter at DFID lunchtime seminar 19th January 2016

Difficult Choices in Health Care Decisions Pre, During and Post Conflict in Sierra Leone

Poster from ReBUILD’s health financing study in Sierra Leone, presented at the 4th Global Symposium on Health Systems Research 16th-18th November, Vancouver, Canada

Resources from ReBUILD’s work on health worker incentives in Sierra Leone, and on health worker experiences during the Ebola outbreak

Details of all outputs from ReBUILD’s work on health worker incentives and remuneration in Sierra Leone, and on health worker experiences during the Ebola outbreak.

Performance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone

The study investigates the absolute and relative contribution of performance-based financing (PBF) to health workers’ income and explores their views on PBF bonuses, in comparison to and interaction with other incomes. The study confirms the complex and interrelated nature of health workers’ remuneration and that the different financial incentives cannot be examined independently from one. It also shows that the way PBF schemes are implemented has an impact on health worker motivation.

Health workforce recruitment and financing – selected issues for consideration

Presentation given by Tim Martineau at the Human Resources for Health Summit in Freetown, Sierra Leone, 2nd June 2016.

Health systems in post-conflict states – Learning from the ReBUILD programme

Presentation given by Joanna Raven on ReBUILD’s work on health systems in post-conflict states, at a Workshop on Rebuilding Health in Yemen after Conflict, 4th June 2016 in Liverpool

Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone’s free health care initiative

This paper reports the findings of a study evaluating the impact of Sierra Leone’s 2010 Free Health Care Initiative (FHCI). It uses two nationally representative surveys to identify the impact of the policy on utilisation of maternal care services by pregnant women and recent mothers as well as the impact on curative health care services and out-of-pocket payments for consultation and prescription in children under the age of 5 years.

Health care seeking behaviour and impact of health financing policy on household financial protection in post conflict Cambodia: A life history approach

This 2015 ReBUILD working paper presents the findings and recommendations from qualitative health financing research in Cambodia

Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone

This 2016 ReBUILD paper investigates the formal and informal payments available to health workers in Sierra Leone

The challenges and opportunities of conducting ethical and trustworthy qualitative research in health systems in post-conflict and fragile contexts: Reflections from a learning community

ReBUILD poster presented at the Third Global Symposium on Health Systems Research in Cape Town 2014: A qualitative study exploring how to strengthen policy and practice related to health financing and human resource management in post conflict and fragile contexts

Equity in Maternal Health Care Services in post-conflict Northern and non-conflict East-Central Uganda: A Comparative Mixed Methods Multi-case study

ReBUILD poster presented at the Third Global Symposium on Health Systems Research in Cape Town 2014: Mixed method study comparing maternal health care in post-conflict and non-conflict regions of East Central Uganda

The Impact of Health Financing Policies on Household Spending: Evidence from Cambodia Socio-Economic Survey 2004 and 2009

ReBUILD Poster presented at the Third Global Symposium on Health Systems Research in Cape Town 2014: Cambodian study measuring the combined effects of user fee and health equity fund on household health expenditure

Health seeking behaviour and impact of health financing policy on household financial protection in post conflict Cambodia: A life history approach

Poster of ReBUILD’s qualitative research on health systems financing in Cambodia presented at the Third Global Symposium on Health Systems Research in Cape Town 2014

Exploring the influence of context and policy on health district productivity in Cambodia

Despite gains in life expectancy and increased health expenditure, Cambodia still lags behind neighbours in many health indicators. This article aims to understand variations in efficiency of public health services, and the extent to which changes in efficiency are associated with key health policies that have been introduced to strengthen access to health services over the past decade.

Understanding contracting in Cambodia: findings from interviews with key informants and health service managers and providers

This research report describes findings from the qualitative component of ReBUILD’s research into health contracting in Cambodia Over the last two decades, Cambodia has implemented several policy initiatives and interventions to improve health service delivery. The contracting of services in the health sector has been happening since the late 1990s. Since 2009, an internal contracting… Read more

Understanding Contracting in Cambodia The performance of contracting and non-contracting districts in extending primary health coverage: analysis of secondary data

This research report describes findings from the quantitative component of ReBUILD’s research into health contracting in Cambodia.

Health financing in post conflict settings

Presentation on health financing in post-conflict settings given by Barbara McPake at Nossal Institute of Global Health in July 2015

Health financing and the budgets of the poor in Zimbabwe Implications for Universal Health Coverage

This brief was produced for the Zimbabwe Health Research Forum on Evidence for Advancing Universal Health Coverage in March 2015, based on ReBUILD’s health systems financing research presented at that meeting.

Research to inform health systems development – An overview of the ReBUILD RPC in Cambodia

This 2015 brief gives a brief outline of the range of ReBUILD’s research in Cambodia, and some of the emerging key findings.

Impact of Health Financing Policies on Household Spending: Evidence from Cambodia Socio-Economic Surveys 2004 and 2009

ReBUILD report into impact of fees, health equity funds, subsidies & vouchers on household health spending in Cambodia.

Evidence and proposals for advancing equity and universal coverage of health services in Zimbabwe

2015 policy brief outlines findings and proposals from ReBUILD’s Rebuilding the foundations for universal health coverage with equity in Zimbabwe

Desk Review of institutional arrangements for health financing in Zimbabwe

Report of a ReBUILD desk study to describe the organizational, institutional & governance aspects of health financing in Zimbabwe.

Desk review of purchasing arrangements for public health services in Zimbabwe

2013 ReBUILD literature review on healthcare purchasing arrangements between government & (i) local government & (ii) private providers in Zimbabwe.

National Research Forum: Evidence for advancing Universal Health Coverage in Zimbabwe ABSTRACTS

This document contains all abstracts from presentations made at the National Research Forum: Evidence for advancing Universal Health Coverage in Zimbabwe, held on 19th/20th March 2015 in Harare, organised by ReBUILD’s Affiliate research partners in Zimbabwe. You can download the full report from this National Research Forum from the TARSC website.

Evidence for advancing Universal Health Coverage in Zimbabwe: Report of the National Research Forum, 19th/20th March 2015

Report of the National Research Forum: Evidence for advancing Universal Health Coverage in Zimbabwe held March 2015 in Harare

Literature Review on Needs Based Resource Allocation

Background literature review to inform field work protocol to develop a resource allocation formula for public health resources in Zimbabwe.

Review of financing of semi-autonomous health institutions in Zimbabwe

Desk study presenting evidence on the funds pooled in and paid by semi-autonomous institutions funding health in Zimbabwe

Desk review of institutional arrangements for health financing in selected African countries

ReBUILD desk study from 2014 on the collection, pooling, purchasing, monitoring & governance of tax-based health financing in several African countries

Catastrophic Payments and Poverty in Cambodia: Evidence from Cambodia Socio-Economic Surveys 2004-11

This 2015 ReBUILD paper estimates the incidence and intensity of catastrophic health payments and their impoverishment effects in Cambodia

Understanding health worker incentives in post conflict settings: Project protocol summary

This document is a summary of the protocol for ReBUILD’s research on understanding health worker incentives in post-conflict settings. It details the approach used for this research across all four of the study countries. You can download the document here.

An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone

This 2015 ReBUILD paper focuses on health worker incentives and payments in Sierra Leone and presents an exploration of district-level implementation processes

Fragile and conflict affected states: report from the Consultation on Collaboration for Applied Health Research and Delivery

Fragile and Conflict Affected States present difficult contexts to achieve health system outcomes and are neglected in health systems research. This report presents key debates from the Consultation of the Collaboration for Applied Health Research and Delivery, Liverpool, June, 2014.

Health systems and gender in post-conflict contexts: building back better?

This narrative literature review is an output of collaborative work between ReBUILD and the Stockholm International Peace Research Institute (SIPRI) working group on gender, to explore the opportunities and challenges for building gender responsive health systems in post conflict contexts.

Health financing in post-conflict settings – a literature review

A 2011 ReBUILD analysis of thinking, approaches, themes and findings of writing on health financing in post-conflict or fragile health systems

Health worker incentives: survey report, Sierra Leone

A 2015 RBUILD report on the need to reach and maintain incentive environments for health workers to support access to equitable health services

Managing the health workforce after a conflict: a review of research and knowledge gaps

A 2014 briefing paper. During conflict, health systems can break down, with clinics and hospitals destroyed and medicine in short supply, leaving people at high risk of disease. Health workers can be targets and many leave the conflict zone. Managing human resources well can help overcome shortages in the health workforce, as well as other… Read more

Evaluating the impact of the Special Operating Agency

Following on from ReBUILD’s study of health contracting arrangements in Cambodia, which concluded that a more robust evaluation of the Special Operating Agency model should be considered, this briefing outlines two options that could be considered for such an evaluation.

From public to private and back again: Lessons Learned from Internal Contracting in Cambodia

This brief provides a summary of ReBUILD’s research done on health contracting in Cambodia, and identifies key points relating to the impact of the Special Operating Agency (SOA) model on service coverage and equity.

Building gender responsive health systems in post conflict contexts: Opportunities and challenges

Building gender responsive health systems in post-conflict contexts: Opportunities and challenges Presentation given at a Global Health, Policy and Practice session 7 March 2014 Read the full presentation

Health Systems in post conflict settings

2015 presentation entitled ‘Current work of ReBUILD: Research for Building pro-poor health systems in the aftermath of conflict’

Contracting in conflict affected settings: evidence from Cambodia

ReBUILD consortium presentation from 2013 on contracting in conflict-affected settings: evidence from Cambodia

Country Situation Analysis: Sierra Leone

A REBUILD consortium Country Situation Analysis for Sierra Leone from 2011

The free health care initiative: how has it affected health workers in Sierra Leone?

In this paper published in Health Policy and Planning, ReBUILD researchers Sophie Witter, Haja Wurie and Maria Bertone explore the effects and implications for health staff of Sierra Leone’s introduction in 2010 of the Free Health Care Initiative (FHCI).

Health financing in fragile and post-conflict states: What do we know and what are the gaps?

As part of ReBUILD’s wider work on health financing, this paper presents an exploratory literature review to analyse the themes and findings of recent writing on health financing in fragile and post-conflict settings.

A case study of health service provision in Yobe State, Nigeria in the context of the Boko Haram insurgency

A 2014 ReBUILD case study of health service provision in Yobe State, Nigeria in the context of the Boko Haram insurgency