Image Credit Left – ©European Union ECHO Mallika Panorat


The challenge we face and how we are addressing it

Fragile contexts are home to… 1

• 8 billion people, or 23% of the world’s population. This figure is expected to rise to 2.2 billion by 2030.

• A third of the world’s children

• 460 million people living in extreme poverty (5% of the global total)

• 95% of the world’s food-insecure people


Fragile contexts are susceptible to shocks and stressors. These include political unrest, conflict and violence, economic and social crises, natural disasters and climate change.

Health systems in these contexts face severe resource constraints and, as this animation demonstrates, shocks and stressors compound their problems. Some health systems will collapse under the pressure, while others will make maladaptive or short-term changes. Others will make positive or resilient responses.


The ReBUILD for Resilience primary research question is therefore:


‘How do we develop resilience capacities to ensure responsive, effective, inclusive, gender-equitable and sustainable health systems in fragile and shock-prone settings?’

What is ‘fragility’?

In its ‘States of Fragility 2020’ report the OECD characterises fragility as:


“The combination of exposure to risk and insufficient coping capacity of the state, systems and/or communities to manage, absorb or mitigate those risks. Fragility can lead to negative outcomes including violence, poverty, inequality, displacement, and environmental and political degradation.”


The framework identifies 57 countries and territories as being ‘fragile’, of which 13 are listed as ‘extremely fragile’. None of these contexts are on track to meet the Sustainable Development Goal on health.


COVID-19 has likely made the situation worse in these fragile contexts.


1 OECD (2020), States of Fragility 2020, OECD Publishing, Paris,

How ReBUILD for Resilience will meet this challenge


There is a shortage of innovative, timely, relevant evidence that demonstrates how we can develop stronger, more resilient health systems – especially evidence generated in partnership with key stakeholders.


ReBUILD for Resilience seeks to meet that need. The consortium will provide high-quality, practical, multidisciplinary, operationally-relevant and scalable health system research, which can be utilised by policymakers and other stakeholders to improve the health and lives of many millions of people.


Within this central focus are a number of key research questions which are explored in the research section. Here we also discuss our theory of change and resilience framework.

"Supporting health systems to absorb, adapt and transform in the face of shocks and stressors is more relevant than ever."

Sophie Witter, IGHD, Queen Margaret University