Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study.

Yazan Douedari,Natasha Howard

doi:10.15171/ijhpm.2018.132

Abstract

Background: Ongoing conflict and systematic targeting of health facilities and personnel by the Syrian regime in opposition-controlled areas have contributed to health system and governance mechanisms collapse. Health directorates (HDs) were established in opposition-held areas in 2014 by the interim (opposition) Ministry of Health (MoH), to meet emerging needs. As the local health authorities responsible for health system governance in opposition-controlled areas in Syria, they face many challenges. This study explores ongoing health system governance efforts in 5 oppositioncontrolled areas in Syria. Methods: A qualitative study design was selected, using in-depth key informant interviews with 20 participants purposely sampled from HDs, non-governmental organisations (NGOs), donors, and service-users. Data were analysed thematically. Results: Health system governance elements (ie, strategic vision, participation, transparency, responsiveness, equity, effectiveness, accountability, information) were considered important, but not interpreted or addressed equally in opposition-controlled areas. Participants identified HDs as primarily responsible for health system governance in opposition-controlled areas. Main health system governance challenges identified were security (eg, targeting of health facilities and personnel), funding, and capacity. Suggested solutions included supporting HDs, addressing health-worker loss, and improving coordination. Conclusion: Rebuilding health system governance in opposition-controlled areas in Syria is already progressing, despite ongoing conflict. Local health authorities need support to overcome identified challenges and build sustainable health system governance mechanisms

Highlights

Syria, a lower-middle-income country in the Eastern Mediterranean, had a population of nearly 21 million in 2010.1 The uprising started in 2011, after the arrest and torture of 15 boys in Dara’a who sprayed school walls with anti-government slogans.[1]
Key Findings This study adds to research on governance in oppositioncontrolled areas in Syria and provides insights into health system governance experiences during conflict
Similar research on Syria focused on general governance or health needs, making this the first study authors are aware of examining health system governance in opposition-controlled areas and including a range of health system voices

Summary

Introduction

A lower-middle-income country in the Eastern Mediterranean, had a population of nearly 21 million in 2010.1 The uprising started in 2011, after the arrest and torture of 15 boys in Dara’a who sprayed school walls with anti-government slogans.[1] Initially non-violent protests soon spread, the Syrian regime responded by arresting and killing protesters,[2,3,4,5] civilians began arming themselves,[6] and nonviolent resistance became armed conflict.[7] As opposition forces took control of many areas, the regime began bombing people and infrastructure.[8,9]. The loss of state and WHO support and restricted activities of traditional humanitarian actors in opposition-controlled areas contributed to a power vacuum that has been filled by a variety of existing health system and grassroots actors

Objectives

Methods

Results

Conclusion