SynthesisPloS one2024
Health system strengthening in fragile and conflict-affected states: A review of systematic reviews.
Synthesis in PloS one, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
62 citing papers in PubMed.
- Managing health systems under armed conflict: a scoping review of international evidence and a document review of Iranian experiences.Global health action · 2026Article
- Systemic challenges in the supply and distribution of medicines in conflict-affected areas of Mali: a qualitative study.Global health action · 2026Article
- Universal Health Coverage on $15 per Capita: Somalia's Health Financing Crisis and the Limits of Humanitarian Dependency.Public health challenges · 2026Article
- Beyond the funding gap: Somalia's aid shock is becoming a primary health-care crisis.Tropical medicine and health · 2026Article
- Bridging primary care with artificial intelligence: toward a global 1.5-Tier Healthcare System.npj health systems · 2026Review
- Medical oxygen as essential health-system infrastructure in Somalia: A call for resilient and equitable access.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2026Article
- Geographical accessibility to hospital care amid armed conflict in Myanmar: a population-weighted analysis of compounding health inequality, 2021-2024.BMJ global health · 2026Article
- Strengthening Primary Health Care for Improved Population Health and Health Equity in Somalia: A Narrative Review.Public health challenges · 2026Review
- Operationalizing public health emergency operations centers in Somalia: a scoping review of challenges and strategies.Tropical medicine and health · 2026Review
- Impact of war on oral health among the Gaza population: a comparative cross-sectional study.BMC oral health · 2026Article
- Enhancing organizational resilience of emergency medical services through a designated intervention program.Israel journal of health policy research · 2026Article
- Medical-Bioethical Mediation as a Potential Governance Innovation for Sustainable, Efficient, and Resilient Healthcare Systems.Healthcare (Basel, Switzerland) · 2026Article
- Clinical recognition of pediatric diphtheria in a resource-limited Somali hospital: a prospective observational study.Tropical medicine and health · 2026Article
- Emergency medical services in low- and middle-income countries: a systematic review of systemic barriers and integration challenges.Preventive medicine reports · 2026Review
- Informal payments and the illusion of free care: a perspective from Somalia's fragile health system.International journal for equity in health · 2026Article
- Strengthening Libya's primary healthcare workforce: a replicable model for health system resilience in fragile states.BMC primary care · 2026Article
- Fragmented geographies and trauma pathways in the Middle East.BMJ global health · 2026Review
- From implementation to learning: a process-oriented framework to evaluate innovative global health capacity building in fragile and conflict-affected settings.Human resources for health · 2026Article
- Healthcare Professionals' Perceptions of Medicine Shortages in Public Health Facilities of the Eastern Cape, South Africa.Healthcare (Basel, Switzerland) · 2026Article
- Getting unstuck: reframing health systems strengthening and resilience in fragile and conflict-affected settings.BMJ global health · 2026Review
2 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGlobally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature.
methodsWe conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet's 'high-quality health system framework'.
resultsTwenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the 'foundations' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation.
conclusionThe emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.