Oral health system strengthening in fragile and conflict-affected states: A systematic review.

Background: Oral diseases affect nearly half of the global population, presenting significant challenges in fragile and conflict-affected states. Despite comprising a population of over one billion people, oral health data and comprehensive evidence on oral health system strengthening on these countries are limited. This study, therefore, aims to explore oral health system strengthening in fragile and conflict-affected states by synthesising evidence from relevant global literature. Methods: We conducted a systematic review of literature across Ovid MEDLINE, EMBASE, Global Health, Scopus, Web of Science, and grey literature databases. The methodological quality of published literature was assessed using the relevant Joanna Briggs Institute critical appraisal tools. The findings were narratively synthesised and presented using the Lancet's high-quality health system framework. Results: The review included 23 papers from 12 countries. The evidence documented impacts of armed conflicts, political crisis, pandemics, and natural disasters on oral health systems, and initiatives to strengthen them focusing on the 'foundations' domain. The initiatives included: workforce development and career opportunities; health service platforms such as mobile dental services and teledentistry; integration of oral health into national health systems and emergency responses; contingency planning and adaptability; and effective governance such as financing systems and infrastructures. Collaborative action, both local and international, including monitoring and evaluation were emphasised as key strategies for health system strengthening to ensure an equitable distribution of responsibilities and resources. Conclusions: Whilst evidence on oral health system strengthening in fragile and conflict-affected states is limited, our findings suggest the need for integrated action, such as mobilising local resources and engaging stakeholders equitably. Further research, with particular focus in the area of processes of care and quality impacts, is necessary to explore comprehensive strategies for strengthening the oral health system.