Abstract
BackgroundThe BRANCH Consortium recently conducted 10 mixed-methods case studies to investigate the provision of health and nutrition interventions for women and children in conflict-affected countries, aiming to better understand the dominant influences on humanitarian health actors’ programmatic decision-making and how such actors surmount intervention delivery barriers. In this paper, the research challenges encountered and the mitigating strategies employed by the case study investigators in four of the BRANCH case study contexts are discussed: Somalia, Mali, Pakistan and Afghanistan.DiscussionMany of the encountered research challenges were anticipated, with investigators adopting mitigation strategies in advance or early on, but others were unexpected, with implications for how studies were ultimately conducted and how well the original study aims were met. Insecurity was a fundamental challenge in all study contexts, with restricted geographical access and concerns for personal safety affecting sampling and data collection plans, and requiring reliance on digital communications, remote study management, and off-site team meetings wherever possible. The need to navigate complex local sociopolitical contexts required maximum reliance on local partners’ knowledge, expertise and networks, and this was facilitated by early engagement with a wide range of local study stakeholders. Severe lack of reliable quantitative data on intervention coverage affected the extent to which information from different sources could be triangulated or integrated to inform an understanding of the influences on humanitarian actors’ decision-making.ConclusionStrong local partners are essential to the success of any project, contributing not only technical and methodological capacity but also the insight needed to truly understand and interpret local dynamics for the wider study team and to navigate those dynamics to ensure study rigour and relevance. Maintaining realistic expectations of data that are typically available in conflict settings is also essential, while pushing for more resources and further methodological innovation to improve data collection in such settings. Finally, successful health research in the complex, dynamic and unpredictable contexts of conflict settings requires flexibility and adaptability of researchers, as well as sponsors and donors.
Highlights
The BRANCH Consortium recently conducted 10 mixed-methods case studies to investigate the provision of health and nutrition interventions for women and children in conflict-affected countries, aiming to better understand the dominant influences on humanitarian health actors’ programmatic decision-making and how such actors surmount intervention delivery barriers
Given the extent of the effects of armed conflict on women and children, and the limited programmatic attention that these effects have received [8,9,10], the BRANCH Consortium (Bridging Research & Action in Conflict Settings for the Health of Women & Children) of international academic investigators and their research, implementation and advocacy partners have been working to improve the evidence base to support effective action on women’s and children’s health and nutrition in conflict settings through a set of interrelated workstreams using a range of methodologies and approaches [11]. These include efforts to better quantify the indirect effects of conflict on maternal and child mortality, and to synthesize and highlight gaps in the existing evidence and guidance on effective intervention delivery strategies in conflict settings. Another workstream has been the development and conduct of mixed-methods case studies to research the provision of sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition (SRMNCAH&N) interventions in 10 conflict-affected countries: Pakistan, Afghanistan, Syria, Yemen, Somalia, South Sudan, Democratic Republic of the Congo, Mali, Nigeria and Colombia [12]
We aimed to highlight and discuss some of the research challenges faced and the corresponding mitigation strategies used by the international research teams conducting BRANCH case studies in Somalia, Mali, Pakistan and Afghanistan (Table 1)
Summary
The BRANCH Consortium recently conducted 10 mixed-methods case studies to investigate the provision of health and nutrition interventions for women and children in conflict-affected countries, aiming to better understand the dominant influences on humanitarian health actors’ programmatic decision-making and how such actors surmount intervention delivery barriers. Given the extent of the effects of armed conflict on women and children, and the limited programmatic attention that these effects have received [8,9,10], the BRANCH Consortium (Bridging Research & Action in Conflict Settings for the Health of Women & Children) of international academic investigators and their research, implementation and advocacy partners have been working to improve the evidence base to support effective action on women’s and children’s health and nutrition in conflict settings through a set of interrelated workstreams using a range of methodologies and approaches [11] These include efforts to better quantify the indirect effects of conflict on maternal and child mortality, and to synthesize and highlight gaps in the existing evidence and guidance on effective intervention delivery strategies in conflict settings. This methodology allowed for an in-depth inquiry into the contextual factors that influenced humanitarian health actors’ programmatic decision-making and, in those cases where sufficient data were available, how those factors related to trends over time in service provision and intervention coverage
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