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Abstract

Health systems are frequently among the casualties of conflict. Within these settings, increased knowledge is needed on how to rebuild and strengthen health infrastructure resilience, such as primary health care (PHC) systems, in context-specific ways that promote health equity. Therefore, this study aimed to explore perspectives of experts with experience working on frontlines of social crises to contribute to understandings of pathways toward equitable PHC in conflict-affected settings. Semistructured qualitative interviews with 18 expert participants were completed. Through engaging elements of grounded theory situational analysis, three themes emerged iteratively, including (a) Building Blocks, (b) Intermediating Factors, and (c) a Roadmap. These emergent themes contribute to conceptual frameworks explaining key contextually specific priorities, challenges, and facilitating factors for developing resilient health infrastructures under social crises. Findings inform policy and practical guidelines that address complexities of conflict conditions and underscore the importance of PHC development toward promoting health as a human right.

Keywords

primary health care health system development health equity health infrastructure resilience conflict-affected regions postconflict qualitative methods situational analysis

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References

Atallah

D. G.

(2016). Toward a decolonial turn in resilience thinking in disasters: Example of the Mapuche from southern Chile on the frontlines and faultlines. International Journal of Disaster Risk Reduction, 19, 92–100. doi:10.1016/j.ijdrr.2016.08.027

Bradley

E. H.

Curry

L. A.

Devers

K. J.

(2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research, 42, 1758–1772. doi:10.1111/j.1475-6773.2006.00684.x

Clarke

A. E.

(2005). Situational analysis: Grounded theory after the postmodern turn. Thousand Oaks, CA: Sage.

Creswell

(2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.

Elzinga

(2005). Vertical–horizontal synergy of the health workforce. Bulletin of the World Health Organization, 83, 242.

Evans

D. B.

Marten

Etienne

(2012). Universal health coverage is a development issue. The Lancet, 380, 864–865. doi:10.1016/S0140-6736(12)61483-4

Frenk

Ferranti

(2012). Universal health coverage: Good health, good economics. The Lancet, 380, 862–864. doi:10.1016/S0140-6736(12)61341-5

Geiger

(2016). The first community health center in Mississippi: Communities empowering themselves. American Journal of Public Health, 106, 1738–1740. doi:10.2105/AJPH.2016.30

Heimerl

(2005). The return of refugees and internally displaced persons: From coercion to sustainability? International Peacekeeping, 12, 377–390. Retrieved from http://www.tandfonline.com/doi/abs/10.1080/13533310500074200

10.

Laska

(2012). Dimensions of resiliency: Essential resiliency, exceptional recovery and scale. International Journal of Critical Infrastructures, 8, 47–62. doi:10.1504/IJCIS.2012.046552

11.

Lincoln

Y. S.

Guba

E. G.

(1985). Naturalistic inquiry. Newbury Park, CA: Sage.

12.

Milliano

C. D.

Faling

Clark-Ginsberg

D. C.

Gibbons

(2015). Resilience: The Holy Grail or yet another hype? In Gibbons

Heintze

H.-J.

(Eds.), The humanitarian challenge (pp. 17–30). Basel, Switzerland: Springer.

13.

Minkler

Wallerstein

(Eds.). (2009). Community-based participatory research for health: From process to outcomes. San Francisco: Jossey-Bass.

14.

Nelson

B. D.

Fehling

Tiernan

Jarrah

Albezreh

Martineau

. . . VanRooyen

(2015). Examining the needs of at-risk youth in the Middle East and North Africa: A multi-method landscape analysis and systematic literature review. Harvard Humanitarian Initiative. Retrieved from http://hhi.harvard.edu/publications/examining-needs-risk-youth-middle-east-and-north-africa-multi-method-landscape-analysis

15.

Olu

Usman

Woldetsadik

Chamla

Walker

(2015). Lessons learnt from coordinating emergency health response during humanitarian crises: A case study of implementation of the health cluster in northern Uganda. Conflict and Health, 9, Article 1. doi:10.1186/1752-1505-9-1

16.

Orenstein

Seib

(2016). Beyond vertical and horizontal programs: A diagonal approach to building national immunization programs through measles elimination. Expert Review of Vaccines, 15, 791–793. doi:10.1586/14760584.2016.1165614

17.

Parmar

Lobb

Purdin

McDonnell

(2007). Enhancing collaboration during humanitarian response: An interim report from stakeholders survey. Prehospital Disaster Medicine, 22, 414–417. doi:10.1017/S1049023X00005136

18.

Peters

D. H.

Garg

Bloom

Walker

D. G.

Brieger

W. R.

Rahman

M. H.

(2008). Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences, 1136, 161–171. doi:10.1196/annals.1425.011

19.

Raviola

Eustache

Oswald

Belkin

(2012). A mental health response in Haiti in the aftermath of the 2012 earthquake: A case study for building long-term solutions. Harvard Review of Psychiatry, 20(1), 68–77. doi:10.3109/10673229.2012.652877

20.

Saldaña

(2009). The coding manual for qualitative researchers. Thousand Oaks, CA: Sage.

21.

Shaikh

B. T.

Haran

Hatcher

(2008). Where do they go, whom do they consult, and why? Health-seeking behaviors in the northern areas of Pakistan. Qualitative Health Research, 18, 747–755. doi:10.1177/1049732308317220

22.

Sousa

Hagopian

(2011). Conflict, health and professional perseverance: Effects of military occupation on healthcare delivery in the West Bank. Global Public Health, 6, 520–533.

23.

SPHERE. (2011). The sphere handbook: Humanitarian charter and minimum standards in humanitarian response. Retrieved from http://www.spherehandbook.org/

24.

Thompson

M. E.

Dorian

A. H.

Harutyunyan

T. L.

(2010). Identifying priority healthcare trainings in frozen conflict situations: The case of Nagorno Karabagh. Conflict and Health, 4, Article 21. doi:10.1186/1752-1505-4-21

25.

Tippens

J. A.

(2017). Urban Congolese refugees in Kenya: The contingencies of coping and resilience in a context marked by structural vulnerability. Qualitative Health Research, 27, 1090–1103.

26.

Wang

X. L.

Chan

C. L.

Shi

Z. B.

Wang

(2013). Mental health risks in the local workforce engaged in disaster relief and reconstruction. Qualitative Health Research, 23, 207–217. doi:10.1177/1049732312467706

27.

Waters

Burnham

Garrett

(2007). Rehabilitating health systems in post-conflict situations. Helsinki, Finland: United Nations University World Institute for Development Economics Research.

28.

Wisner

Kelman

(2015). Community resilience to disasters. In Wright

J. D.

(Ed.), International Encyclopedia of the social & behavioral sciences (2nd ed., pp. 354–360). Amsterdam, The Netherlands: Elsevier.

29.

World Health Organization. (2002). World report on violence and health. Geneva, Switzerland: Author.

30.

World Health Organization. (2012). The world health report 2008: Primary health care: Now more than ever. Geneva, Switzerland: Author.

31.

World Health Organization. (2013). Declaration of Alma-Ata: International conference on primary health care, Alma-Ata, USSR, 6-12 September 1978. Available from Who.int

32.

World Health Organization. (2016). Framework on integrated people-centered health services. Geneva, Switzerland: Author. Retrieved from http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/

33.

Zoraster

R. M.

(2006). Barriers to disaster coordination: Health sector coordination in Banda Aceh following the South Asia Tsunami. Prehospital Disaster Medicine, 21, 13–18.

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Developing Equitable Primary Health Care in Conflict-Affected Settings: Expert Perspectives From the Frontlines

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