Journal of African Development

Introduction

Decades of armed conflict have profoundly debilitated health systems in many parts of Africa, causing destruction of facilities, shortages of health workers, depleted supplies, and fragmented delivery. With the cessation of hostilities, post-conflict states face the dual imperative of addressing acute health needs and building resilient health systems capable of withstanding future crises.

The Impact of Conflict on Health Systems

• Infrastructure Destruction: Widespread destruction of hospitals, clinics, and supply chains leaves populations with little access to care.
• Human Resources Crisis: Conflict results in displacement or loss of health workers, as seen in Sudan and Northern Uganda, leaving health facilities critically understaffed^[1].
• Health Burden: Disease outbreaks, trauma, maternal mortality, and malnutrition soar as populations lose routine care^[1][2].
• Governance Gaps: Weak institutions and poor policy environments undermine strategic planning and coordination^[3].

Table 1: Key Health System Disruptions in Conflict-Affected African Countries

Framework for Health System Strengthening in Post-Conflict Contexts

WHO Health System "Building Blocks"

• Service Delivery
• Health Workforce
• Health Information Systems
• Medical Products, Vaccines, and Technologies
• Financing
• Leadership and Governance

Efforts to rebuild must address each of these elements in an integrated, context-specific way^[6][4].

Strategies and Approaches

1. Restoring Essential Health Services

• Focus on Primary Health Care (PHC): PHC serves as the foundation in post-conflict recovery, targeting disruptions in maternal, child, and communicable disease care^[2].
• Mobile Clinics & Telemedicine: These innovations extend care to remote or insecure communities unable to access damaged facilities^[1].

2. Rebuilding and Expanding Infrastructure

• Physical Rehabilitation: Reconstructing or repairing hospitals and clinics to withstand future hazards, as implemented in northern Uganda^[4].
• Community-Based Health Posts: Integrating local participation fosters ownership and supports reconciliation^[5].

3. Health Workforce Development

• Training and Retention: Capacity-building programs target both community health workers and returning displaced professionals^[6][1].
• Supportive Supervision: Ongoing mentorship and supervision enhance quality and morale^[6].

4. Strengthening Governance and Coordination

• Inclusive Planning: Participation of local communities, civil society, and all levels of government is essential for legitimacy and relevance^[7][3].
• Decentralized Leadership: Delegating authority to local health authorities accelerates recovery and adapts responses to ground realities^[6].

5. Financing and Resource Mobilization

• Pooling Funds: National, donor, and humanitarian funds are aligned and disbursed rapidly, as in the early phases of Sudan’s recovery^[3].
• Transition from Humanitarian to Development Aid: Timely shift of resources sustains health system gains beyond the emergency stage^[8].

6. Integrating Disaster Risk Reduction (DRR) and Resilience

• Mainstreaming DRR: Incorporating risk management into reconstruction planning strengthens health system resilience^[9].
• Preparedness Planning: Establishing emergency preparedness and response capacities as part of health sector reforms fortifies future shock response^[9][4].

Case Studies

Northern Uganda

After two decades of conflict, the region’s health recovery strategy aimed to ensure equitable access through PHC, integration of DRR, and rebuilding six WHO building blocks. The strategy’s success included better access to services, improved disaster preparedness, and more resilient infrastructure. Community participation in planning fostered reconciliation and reduced system vulnerability^[4].

Sierra Leone, Zimbabwe, South Sudan

• Sierra Leone: Stable funding and local partnership enabled sustained HSS and more robust emergency response mechanisms^[10].
• Zimbabwe: Post-crisis rebuilding focused on stakeholder co-production and long-range needs assessments, leading to improved service delivery and planning^[10][7][11].
• South Sudan: Rapid assessments and streamlined donor funding mechanisms were critical to restoring fragmented health service delivery^[3].

Ethiopia and Other Sub-Saharan States

Collaborative research approaches emphasizing stakeholder engagement and participatory planning provided a systematic diagnostic and informed program design across diverse contexts^[7].

Persistent Challenges

• Chronic Underfunding: Humanitarian financing falls short of needs, and development funding delays threaten sustainability^[8].
• Fragmentation: Multiple actors may lead to parallel systems, inefficiencies, and duplication^[5][3].
• Workforce Retention: Security concerns and weak incentives hinder return and retention of health professionals^[6][5].
• Quality of Care: Short-term service expansion sometimes comes at the expense of quality, especially without ongoing supervision and investment^[8].
• Equity and Inclusivity: Vulnerable groups such as women, children, and the disabled may be left behind in recovery plans unless equity is prioritised^[9][4][1].

Real-World Data and Visualizations

Table 2: Progress in Selected Post-Conflict African Countries (2010-2024)

*Estimates based on government and UN sources^[4][10][3].

Figure 1: Illustrative Paths to Health System Recovery

• Conflict ➔ Infrastructure loss ➔ PHC outreach & mobile clinics ➔ Workforce development ➔ Inclusive planning & DRR ➔ Sustainable, equitable systems^[6][9][4][1].

Recommendations and Policy Priorities

• Develop Country-Specific Frameworks: Context matters. Frameworks must match each country’s unique social, economic, and political landscape^[9][4][3].
• Prioritize Equity: Gender, age, disability, HIV/AIDS, and mental health should be explicit pillars in recovery plans^[9][4][1].
• Promote Ownership and Participation: Emphasize local leadership, community involvement, and continuous learning^[7][5][3].
• Sustain Investments: Governments and international partners must commit to sustained financing, capacity development, and institutional support^[8].
• Integrate DRR into Health Strategy: Streamline preparedness and risk reduction into health sector policies for resilience^[9][4].
• Strengthen Data Systems: Investment in health information systems supports monitoring, planning, and accountability^[6][7].

Conclusion

Effective health system strengthening in post-conflict Africa demands a holistic, participatory, and resilience-focused strategy, centered on restoring essential services, rebuilding workforce and infrastructure, fostering inclusive governance, and mainstreaming disaster risk reduction. Experiences from Uganda, Sierra Leone, and South Sudan, among others, highlight the promise and necessity of integrated, locally driven initiatives. Sustainable progress rests on continued investment, policy coherence, and a steadfast commitment to equity and resilience for all.