Rebuilding health post-conflict: case studies, reflections and a revised framework.

War and conflict negatively impact all facets of a health system; services cease to function, resources become depleted and any semblance of governance is lost. Following cessation of conflict, the rebuilding process includes a wide array of international and local actors. During this period, stakeholders must contend with various trade-offs, including balancing sustainable outcomes with immediate health needs, introducing health reform measures while also increasing local capacity, and reconciling external assistance with indigenous legitimacy. Compounding these factors are additional challenges, including co-ordination amongst stakeholders, the re-occurrence of conflict and ulterior motives from donors and governments, to name a few. Due to these complexities, the current literature on post-conflict health system development generally examines only one facet of the health system, and only at one point in time. The health system as a whole, and its development across a longer timeline, is rarely attended to. Given these considerations, the present article aims to evaluate health system development in three post-conflict environments over a 12-year timeline. Applying and adapting a framework from Waters et al. (2007, Rehabilitating Health Systems in Post-Conflict Situations. WIDER Research Paper 2007/06. United Nations University. http://hdl.handle.net/10419/63390, accessed 1 February 2018.), health policies and inputs from the post-conflict periods of Afghanistan, Cambodia and Mozambique are assessed against health outputs and other measures. From these findings, we developed a revised framework, which is presented in this article. Overall, these findings contribute post-conflict health system development by evaluating the process holistically and along a timeline, and can be of further use by healthcare managers, policy-makers and other health professionals.