Delivering primary healthcare in conflict-affected settings: A review of the literature.

Abstract

Conflict is often destructive to existing services and exacerbates population health inequities and the vulner-abilities of existing healthcare. We undertook a scoping review of the literature concerning delivery of primary healthcare (PHC) in post-conflict settings. We undertook a scoping review of the peer-reviewed and gray literature to identify articles related to the development and delivery of PHC in post-conflict settings. We searched PubMed/Medline, Cochrane Library, Em-base/Ovid, CAB abstracts, POPLINE, and WHO.int. between January 1990 through the December end of 2017, for arti-cles in the English language. Two researchers independently assessed each article and applied inclusion criteria: refer-ring to post-conflict settings and a range of terms related to PHC or health system development. Search terms were selected by careful review of the World Health Organization's analytical framework for developing a strategy on univer-sal coverage and analysis according to the availability, accessibility, affordability, and acceptability of healthcare and further themes involving demand-side or user-side concerns. Findings were captured to reflect a range of conflict-affected settings and varied priorities and approaches to PHC reconstruction. Integrated immediate and longer-term strategies, involving needs-assessments, effective ad-ministration, development of institutions, and cost-efficient investment in human resources, infrastructure, and capacity building are needed to deliver expanded and equitable services, responsive to population health needs, critical to the delivery of equitable PHC. Scoping review of the literature may be formative in the generation of evidence-base to inform delivery of universal PHC, when applied according to context specificity of conflict-affected setting.