Top-down Approach Research Articles

Participatory multi-criteria decision making for optimal siting of multipurpose artificial reservoirs

Water resources management is a crucial activity due to climate change concerns and increasing water scarcity. The increase of water storage by building new artificial reservoirs is one of the most common solutions to fulfill the community’s needs for potable water, energy, irrigation, and prevention of flood risk. The siting of the reservoirs is usually assessed based on topographical and hydrological considerations. However, there are additional crucial factors, often disregarded in common engineering top-down design approaches, that should be considered to determine suitable locations, such as bio-physical, socio-economic, regulatory, and environmental factors, especially where there are competing interests in the use of territory. Involving the communities in the initial stages of the decision-making process is therefore crucial. In this work, we present a methodology, based on multi-criteria decision-making analysis (MCDA), for identifying the optimal locations for new reservoirs while simultaneously addressing all the aforementioned factors through community engagement. The presented method aims at overcoming two major challenges in existing works, i.e., retrieving quantitative information from the participatory approach and going beyond standard hydro-morphological suitability of a dam site. In a first step, an algorithm assesses a large number of sites using a Digital Elevation Model (DEM). Then, MCDA is conducted to rank all potential locations. The selection criteria are defined quantitatively, based on a territorial analysis combined with hydrological modelling. The criteria include: geometric and morphological aspects (reservoir volume, etc.), hydrological indicators (water balance, potential flood mitigation), anthropization (population, infrastructures, etc.), landscape, archaeological heritage, ecology, environmental components and natural hazards. A web-based survey tool based on the pairwise comparison is developed to engage the community in the decision-making process, allowing them to express their perspectives on the relative significance of each criterion. The application of this methodology is demonstrated through a case study in the Pesa river watershed, Italy, showcasing its effectiveness in identifying the most suitable reservoir locations while targeting the highest environmental preservation and community acceptance. The results show that sole engineering criteria might not reflect the sensibility of the community and that variations of the size of the dam can lead to distinct trade-offs between costs and benefits where interference with impact elements occurs.

Gábor Transform-Based Antibody Quantitation in Serum: An Interlaboratory Liquid Chromatography/High-Resolution Mass Spectrometry Investigation.

Therapeutic monoclonal antibodies (t-mAbs) are crucial for treating various conditions, including cancers and autoimmune disorders. Accurate quantitation and pharmacokinetic monitoring of t-mAbs in serum are essential, but current methods like ligand binding assays (LBAs) and bottom-up peptide liquid chromatography-tandem mass spectrometry (LC-MS/MS) can lack the sensitivity and specificity needed to meet clinical demands. Emerging techniques using high-resolution mass spectrometry (HRMS) in top-down and middle-up approaches offer improved ability to accurately quantify mAb proteoforms apart from degradation products by keeping the sample proteins intact or minimizing digestion. This study describes the first use of Gábor transform (GT)-based iFAMS Quant+ software to quantify a t-mAb (vedolizumab) from ∼400 samples using an Agilent 6545XT AdvanceBio Q-TOF at the University of Oregon. These results are compared to a previously validated laboratory-developed test (LDT) from Mayo Clinic utilizing a Thermo Q Exactive Plus Orbitrap. The Mayo method used conventional extracted ion chromatograms (XICs) of select charge states for quantitation, while the iFAMS Quant+ method utilized GT-based charge state deconvolution, background subtraction, and signal integration. Calibration and quality control (QC) analyses and Passing-Bablok regression of 351 subject samples demonstrated excellent agreement between the two methods. The iFAMS Quant+ workflow exhibited unique advantages for characterizing interferents and analyte signal anomalies due to its deconvolution-based approach.

Exploring an adaptive management model for “status-optimization-regulation” of mining city in transition: A case study of Huangshi, China

Mining cities face the challenges of ecological transformation and sustainable development after mineral depletion. Thus, ecological space optimization and adaptive management are pivotal after ecological restoration project, but easily neglected. Taking Huangshi in Hubei Province as an example, a top-down adaptive management model for regional mining ecological space integrating status-optimization-regulation (SOR) was established based on land system resilience (LSR) evaluation, circuit theory, complex network model and community discovery algorithm. The results showed that i) As the LSR increased, the land use structure shifted from non-ecological zones to forest and cropland, indicating that balancing agriculture and forest protection was crucial for increasing LSR in Huangshi. i) The ecological networks (ENs) of Huangshi had an irregular fishnet pattern, with densely intricate corridors in the south and broader, sparser ones in the north, and numerous ecological barriers near the mining area. Furthermore, the distribution of ecological sources and corridors displayed complementarity and hierarchy. iii) The optimized ENs exhibited higher connectivity and efficiency under disturbance, reducing corridor redundancy and migration costs. iv) The ENs clusters were classified into five types based on ecological connectivity: ecological buffer zone, priority restoration zone, moderate restoration zone, natural restoration zone, and moderate development zone, and tailored ecological regulatory strategies were proposed. The findings provide practice-oriented guidance for the sustainable development of mining cities, and offer a direct approach to support conscious, clear, and coherent adaptive management of ecological restoration in rapidly changing environments.

The Role of Workplace Communication on Employees’ Performance in Tanzania: A Case of Tanzania Electric Supply Company (TANESCO)

Effective workplace communication is pivotal in enhancing employee performance, particularly in today's global business environment characterized by diversity and remote work dynamics. This study aimed to examine the role of workplace communication on employee performance within Tanzania Electric Supply Company Limited (TANESCO), focusing on how communication influences job correctness, decision-making, planning, and overall employee productivity. The study utilized a descriptive research design to collect data. A total of 36 participants were sampled using simple random. Data were gathered through questionnaires and analyzed using SPSS for quantitative data insights. The findings indicate a significant correlation between effective communication and enhanced employee performance. Specifically, open communication with supervisors was strongly linked to increased job correctness and performance (mean = 4.81). Communication was also found to facilitate decision-making and planning (mean = 3.53), and there was a recognized relationship between effective communication and overall employee performance (mean = 3.97). However, the traditional top-down communication approach was noted, with a mean score of 3.65, suggesting areas for improvement in adopting more inclusive communication practices. The study confirms the critical role of effective workplace communication in enhancing employee performance at TANESCO. Open and transparent communication, particularly with supervisors, significantly contributes to job accuracy and employee productivity. The study recommends that TANESCO implements structured programs to foster open dialogue, develops comprehensive communication strategies that balance hierarchical and inclusive approaches, and invests in regular training and assessment of communication practices. Additionally, adopting an 'open door' policy and engaging in active listening are suggested to enhance the communication framework within the organization.

The Suku Laut View of the Settlement Program in Lingga Regency

Abstract: This research analyses the views of the Suku Laut on development policies that have resettled them from a nomadic life at sea to a sedentary life on land. The top-down development approach often does not actively involve the Suku Laut, leading to various responses. The research method used was descriptive qualitative, with in-depth interviews and observations of 10 informants of the Sea Tribe in the Riau Islands. Peter L. Berger's social construction theory analyzed how social change occurs through externalization, objectivation, and internalization. Based on the research results, two main views of the Suku Laut towards development policies resulted from social construction. Both views reflect the complex dynamics of identity, access, and interaction with the new social environment. Firstly, some felt that development was not inclusive because it threatened their cultural identity, access to resources, and lack of involvement in decision-making. Secondly, some Suku Laut consider the policy sufficient to fulfill their basic needs, such as education, health, and protection from extreme weather. These different views are influenced by their living patterns, whether they are still nomadic, settled on the coast, or land. This article shows that the change from nomadic to settled life results from social construction created through the interaction of the Suku Laut with external society

Barriers Impeding the Contribution of Indigenous Knowledge to Rural Development in Mabheleni, South Africa

Indigenous knowledge is increasingly recognised as a critical resource in rural development practice in many African countries, South Africa included. However, the use and contribution of indigenous knowledge in the development of rural communities in South Africa is inhibited by numerous factors. Drawing from the lens of deliberative democracy, this article reports on a study that explored the barriers impeding the contribution of indigenous knowledge towards rural development in Mabheleni. This deep rural and underdeveloped community falls under the Umzumbe Municipality in KwaZulu-Natal, South Africa. This study used a qualitative approach. Semi-structured interviews were conducted with 10 participants and one focus group discussion with 10 participants in Mabheleni. Thematic analysis was used to analyse the data. The study findings indicated that lack of recognition of indigenous knowledge itself in development practice, the use of a top-down approach by government officials, and barriers to community participation impede the potential contribution of indigenous knowledge to rural development. Therefore, the study recommends a bottom-up approach to rural development practice.

A systematic review of decarbonization pathway and modeling conception in iron and steel industry at micro-, meso-, and macro-levels.

To meet the carbon-neutral goal in 2050, an accelerated transition of decarbonization is needed in the iron and steel industry. Lots of decarbonization path models are recently being used to analyze the technology pathways, industrial structure adjustments, and short- or long-term policies for greenhouse gas emission reduction. Thus, systematic insight is required for better making sense of the status quo and differences in low-carbon transition pathways at different levels. This paper reviews the carbon emission reduction of steel production routes and summarizes the decarbonization models from micro-, meso-, and macro-level perspectives, respectively. First, we systematically analyze the capacity and potential of both available and emerging technologies in the iron and steel production process. Additionally, we conduct a theoretical analysis of the bottom-up models currently used as effective tools to assess decarbonization technology pathways. Subsequently, pathways and models in terms of industrial synergy are elaborated. Policy guidance and market support are explored to overcome the challenges of collaborative carbon reduction faced by global steel producers. The characteristics of top-down models for supporting carbon reduction are also discussed. Finally, gaps in the literature and future research agendas are identified. Advancing this research could enrich discussions on steel industry decarbonization and provide clearer assessments of modeling approaches. The results indicate that existing energy-saving technologies in the iron and steel industry have limited carbon reduction capacity. Significant reduction requires coordinated efforts with upstream and downstream industries, particularly in hydrogen and power sectors, along with financial support and favorable policies.

Achieving the 1D Atomic Chain Limit in Van der Waals Crystals.

Experiments with graphene have demonstrated that 2D van der Waals materials can be stable, robust, and efficiently manipulated at the level of individual atomic planes. However, the stability and manipulation of 1D van der Waals materials and individual atomic chains remains elusive. Here, the ability to exfoliate and process two representative van der Waals materials containing 1D motifs, namely MoI3 and Ta2Se8I, at the scale of individual atomic chains is demonstrated. High-resolution transmission electron microscopy and atomic force microscopy studies confirm the presence of stable individual atomic chains of MoI3 at room temperature. It is further shown that 1D van der Waals materials with low exfoliation energy, such as Ta2Se8I, can be processed with electron beams to achieve suspended individual atomic chains. Ab initio calculations corroborate the findings regarding the cleavage energies and the thermodynamic stability of individual atomic chains in these 1D van der Waals materials. These results demonstrate that the top-down approach in material processing can be extended to the scale of individual chains.

Progress and challenges in the synthesis of two-dimensional Van der Waals ferroic materials and heterostructures

Abstract Two-dimensional ferroelectric and magnetic van der Waals materials are emergent platforms for the discovery of novel cooperative quantum phenomena and development of energy-efficient logic and memory applications as well as neuromorphic and topological computing. This review presents a comprehensive survey of the rapidly growing 2D ferroic family from the synthesis perspective, including brief introductions to the top-down and bottom-up approaches for fabricating 2D ferroic flakes, thin films, and heterostructures as well as the important characterization techniques for assessing the sample properties. We also discuss the key challenges and future directions of the field, including scalable growth, property control, sample stability, and integration with other functional materials.

Quasi-one-dimensional bismuth chains with topological properties

One-dimensional (1D) systems have received a lot of attention due to their exotic physical phenomena such as quantization of conductance, Peierls instability, and Luttinger liquid behavior. Here, we present the synthesis of self-assembled quasi-1D bismuth (Bi) chains on an Au(111) substrate, highlighting their topological properties. Scanning tunneling microscopy and spectroscopy measurements reveal that the high-quality large area array is composed of Bi atomic chains with a bandgap of 0.5 eV. Density functional theory (DFT) calculations confirm the experimental observation and reveal the topological properties of the system, providing evidence of the spin texture of the Bi atomic chains. Our DFT results predict that a single Bi chain hosts exotic topological properties. The atomically precise synthesis of Bi atomic chains overcomes the limitation of the top-down approach toward integration of devices. The work sheds light on the realization of 1D system, providing a platform for further investigation into the intriguing physics in 1D systems.

The Organization Man Paradox

Herein we examine the paradox faced by an individual after joining a large or ganization.The paradox is related to the phenomenon of the Organization Man, rst identi ed in the middle of the last century and is addressed herein using a large-scale numerical calculation of the network dynamics modeling the or ganization. This network model reduces to a fractal-order Langevin equation model of the dynamics for a single individual embedded in a complex network. An analytic solution for describing the subtle, yet dramatic, in uence of the organization (complex network) on the decision making behavior of an individ ual member of the organization is obtained. Furthermore, this adoption of the organizational behavior by the individual is the result of the way people interact with one another and is not necessarily a consequence of any overt e¤ort on the part of the organization to in uence individual behavior. In fact it is shown that a top-down approach to controlling individual behavior is unstable, whereas a bottom-up approach is resilient.

Between smart housing and home. EU-funded climate smart interventions in Swedish public housing

Smart housing and its consequences for tenants is still a largely absent field in smart city and housing research. Departing from the EU-funded project GrowSmarter, 2015–2019 and a renovation project of a 1960s housing complex in Stockholm, the article investigates tensions around retrofitting older apartment blocks to make them climate smart. The article presents the argument that top-down approaches of EU-funded climate-smart city interventions leave minimal space for different stakeholders to steer the process and limits the tenants’ role and influence. Researching the implementation of smart technology in housing renovations and how it ultimately effects tenants’ everyday lives, the article adds to previous knowledge of uneven development of climate smart solutions through bringing in the outcomes of housing renovation projects, and how ‘actual smart cities’ are played out within the housing sector. The article brings together research on climate urbanism, housing studies and smart cities with the purpose to understand the scalar politics of smart implementations and the effects on tenants.

No need to be rebellious: placemaking and value co-creation in the skateboarding City of Malmö.

During the last 20 years, Malmö has developed into an internationally recognised skateboarding destination and a valued skateboarding place for local and regional skaters. In contrast to many cities, skateboarding and skateboarders have been appreciated and embraced in public planning and development. The aim of the paper is to discuss the development and identity of Malmö as a skateboarding city through the lens of the concepts of placemaking and value co-creation, and-not least-through the narratives of six persons with different relations to skateboarding and Malmö. The paper shows that the City of Malmö has engaged with local skateboarding communities through several initiatives that have fostered a collaborative relationship. The non-profit association Bryggeriet, a skateboard high school, an active skateboarding community, and the City of Malmö are all involved in the placemaking and co-creation of Malmö as a skateboarding city. The city's approach to skateboarding involves a bottom-up strategy, engaging non-experts in the development of spaces, reflecting a shift from traditional top-down models towards a co-creation model in order to create synergetic outcomes. Malmö's transformation into a skateboarding city is characterised by the integration of skateboarding into the urban fabric, showcasing a welcoming attitude. The paper underscores the dynamic interplay between physical, imagined, and lived spaces in urban skateboarding culture. However, it also demonstrates how a successful and professionalised model for introducing the skateboarders' interests into the corridors of power risks undermining the link to, and the engagement of, the new generation of grassroots skaters, and maybe also the edgy, rebellious character of skateboarding.

Challenges Faced on Strategic Management in Somaliland Public Sector Institutions

This study examined the challenges encountered in strategic management in Somaliland public sector institutions, specifically the study looked at how strategies are developed,implementation of strategy and its role in organizational performance, obstacles that hinder successful strategy implementation, and the role of evaluation of strategy in institutional success. The study employed a mixed-methods approach involving both quantitative and qualitative research approach. The population for this study was 5,000 employees from 38 public sector institutions in Hargeisa, Somaliland, with a sample size of 374. The primary data was collected through questionnaire distributed to 354 participants using online data collection tools such as Google form where 324 questionnaires were returned successfully, as well as conducting key informant interview with 16 top and senior managers and 15 lower staffs. The quantitative data was analyzed with a descriptive statistics using MS Excel and Statistical Packages for Social Science (SPSS), while the qualitative data gathered through the interview analyzed through content analysis. The findings showed that while there were strategy formulation process in place in Somaliland public sector institutions, they don’t have clear and consistent implementation throughout the different levels of employees. The major challenges encountered Somaliland public sector institutions in strategy implementations was as results indicated, insufficient allocation of resource, lack of adequate training of employee on strategy, poor leadership, inflexible and top-down approach as a major challenges in successful implementation of strategy in Somaliland public sector institutions. The research highlighted the vital role of systematic strategy evaluation in enhancing institutional performance, but existing practices in Somaliland public sector institutions deemedinadequate. The results showed that strategy evaluation is limitedto senior managers and there is poor stakeholder involvement in strategy evaluation. The study recommends in enhancing involvement of stakeholders during all the faces of strategic management, matching the budget and strategy objectives, improving communication and training, supporting adaptable leadership, and finally, implementing effective monitoring and evaluation mechanism to ensure the strategy objectives achieved to enhance strategic management in Somaliland public sectorinstitutions.

The inclusive data governance models for algorithms – a dream of the already convinced or a realistic way of action?

ABSTRACT The article presents the implications of personal data governance models for algorithmic discrimination. It reflects on the significance of engaging with data subjects to prevent or mitigate discrimination by comparing the effectiveness of the top-down and bottom-up approaches to data governance. The paper goes beyond the option to either decline or agree to terms of service while entering online platforms and argues that bottom-up data governance models of data trusts and information fiduciaries can be more inclusive than the top-down data governance.

Estimating the fishing rate for maximum nutritional yield (FMNY) optimizes fish production for human health

Abstract Fisheries management is largely based on the principle of achieving the maximum sustainable yield (MSY) with little regard for nutritional value. Management strategies maximizing nutrients rather than yield, however, may provide a smarter contribution to global food and nutrition security. Here, we present a novel fisheries management strategy: fishing at maximum nutritional yield (FMNY), the exploitation rate at which essential nutrients are maximized. Combining top-down population modelling approaches with bottom-up nutrient compositional analysis, we compared nutrient yields across seasons for Europe’s most valuable fishery (Atlantic mackerel, Scomber scombrus). FMNY estimates differed between nutrients, but were equal to, or lower than, FMSY. An autumn fishery provided higher amounts of lipids, omega-3 fatty acids, and protein, whereas vitamin D3, and calcium were maximized in winter. Aligning national fisheries policies and nutrition objectives is paramount to realising the potential of seafood in building healthier food systems. Developing novel fisheries management strategies, such as FMNY, where fisheries are optimised for human nutrition will, therefore, contribute to nutrient sustainability and help improve human health and diets.

Design and fabrication of plant-based milk fat globule mimetics: Flaxseed oil droplets coated with potato, soy, or pea protein

An increasing number of plant-based milk products are appearing on the market as substitutes for dairy milk. These products are becoming more popular due to growing consumers concerns about environmental, health, or ethical issues linked to dairy milk. Typically, plant-based milks are produced using top-down approaches that involve mechanical disruption of plant tissues. In this study, we examined the possibility of using a bottom-up approach to mimic the structural and physicochemical properties of milk fat globules (MFGs) in homogenized milk. Plant-based MFGs (PB-MFGs) were prepared using flaxseed oil as an omega-3 fatty acid rich oil phase, and potato, soy, or pea protein as emulsifiers to create the interfacial membranes. PB-MFGs were prepared with the same oil content (10 %) but different protein contents (0.5, 1, 1.5, and 2 %). The mean particle diameters (d4,3 and d3,2) of the three types of PB-MFGs were slightly smaller than those of dairy MFGs, while their surface charges were somewhat more negative under neutral conditions. There was no significant difference in the shear viscosity of PB-MFGs and MFGs. In terms of stability, PB-MFGs prepared with potato protein exhibited the smallest particle size change after 30 days of storage. Moreover, the pH stability of these PB-MFGs was closest to that of dairy MFGs. Our results provide valuable insights into the design and development of plant-based milks with more dairy-like properties, which may increase their more widespread acceptance and application.

7864 Accurate Machine Learning-Based Diagnosis of At-Risk MASH and MASLD Subtypes Using Categorical Gradient Boosting and Select Clinical, Biochemical, and Metabolomic Measurements: Building Highly Robust Models With Few Variables Through a Multinational, Multi-Center, Biopsy-Proven Cohort

Abstract Disclosure: K. Stefanakis: None. E. Axarloglou: None. C.S. Mantzoros: None. Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by intrahepatic lipid accumulation, may precipitate steatohepatitis (MASH) and liver fibrosis, and is a significant cardiometabolic risk factor. Liver biopsy, though invasive and costly, is the diagnostic gold standard, thus creating an unmet clinical need for accurate and reliable non-invasive diagnostic methods to diagnose MASLD, particularly the combination of MASH and significant fibrosis, classified as “at-risk MASH” and known to markedly increase morbidity and mortality. We aimed to leverage novel machine-learning (ML) algorithms to create lightweight but highly precise models that may accurately diagnose at-risk MASH and related histological outcomes through a top-down approach. This is a study of 443 participants from two Gastroenterology-Hepatology Clinics (Greece, Australia) and one Metabolic Surgery Clinic (Italy), including healthy controls and MASLD patients across the entire spectrum of the disease. All participants underwent liver biopsies, anthropometric, standard biochemical and additional hormonal measurements, and global serum metabolomics using ultra-high-performance liquid chromatography-tandem mass spectrometry, followed by robust batch correction and quality control, eventually identifying 687 known and 152 unknown metabolites. The dataset was randomly divided into a discovery (n=353) and a validation cohort (n=90) ensuring a balanced distribution of at-risk MASH and clinic. Our main ML pipeline implemented Categorical Gradient Boosting Machines using the CatBoost package for R. We pre-specified domain knowledge variables and implemented recursive feature elimination, among additional techniques, to build models through an iterative, algorithm-based process. The models were tested in the validation and entire cohort using k-fold and leave-one-out cross-validation with random resampling, and further assessed on relevant subgroups (MASLD status, obesity, diabetes, clinic, country). The main ML model consists of three routine clinical and biochemical variables, supplemented by two aminoacid metabolites (full model to be shown), and can detect the presence of at-risk MASH with a mean AUROC of 93% and mean accuracy of 92% in the validation cohort, and AUCS>93% with very high sensitivities and specificities per J-statistic in all subgroups. We likewise present ML models for the detection of MASLD, MASH, and fibrosis grades, with AUCs of over 90% in the validation cohort and all subgroups. Our models significantly outperform all applicable biomarker-based indices per DeLong’s tests. Further enhancement with lipidomic and proteomic variables will fully delineate the circulating biochemical snapshot of MASLD and likely lead to even more accurate, similarly structured models. Presentation: 6/1/2024

Structure-property relationships of polydisperse open-cell foams: Application to melamine foams

The melamine foam presents a unique microstructure characterized by an interconnected network of solid struts, which form the edges and faces of high porosity open cells. This study investigates the influence of pore size distribution on acoustic properties for three commercially available melamine foams. Based on the measured transport parameters, a top-down approach is employed to determine the equivalent Kelvin-cell size corresponding to each transport parameter. The differences found in these equivalent pore sizes indicate that the mono-size model is not suitable for these materials, a difference from which a quantitative estimate of the level of polydispersity can be deduced (using macro-scale information). The polydispersity was confirmed from experimental evidence at micro-scale from the analysis of SEM images. Moreover, the measurements collected at micro-scale (average pore size and its standard deviation) can be used as input data to determine the transport and sound absorbing behavior of melamine foam samples from structure-property relationships available for open cell microstructures. This work provides evidence that the polydispersity of melamine foams should be taken into account to obtain an accurate and consistent picture of microstructure and transport properties of such open cell high porosity foams.

Capturing sources of health system legitimacy in fragmented conflict zones under different governance models: a case study of northwest Syria

IntroductionLegitimacy and trust are crucial for resilient health systems in fragmented conflict zones. This study evaluates the legitimacy of health systems in northwest Syria under different governance models.MethodsUsing a deductive and inductive mixed-methods approach, the research team developed a framework with an index, 4 sub-indices and 18 indicators to assess the legitimacy of health systems using different governance models – top-down, bottom-up, and hybrid – in the context of the response to the earthquake that hit Syria in February 2023. The study includes surveys, workshops, stakeholder consultations, and an expert panel conducted in northwest Syria and online.ResultsThe findings indicate that bottom-up health governance model is perceived as the most legitimate, followed by the mixed model, while top-down model is perceived as the least legitimate. This preference is measured across all legitimacy source sub-indices, including legality, justification, consent and performance and across the overall Health System Legitimacy Index (HSLI). However, the hybrid governance approach showed limited superiority at two indicator levels regarding long-term health system response.ConclusionThis study highlights the importance of considering the legitimacy of the health system in fragmented conflict zones. It helps explain the effectiveness of the bottom-up approach and community-based governance in enhancing trust, cooperative behaviour, health interventions and achieving sustainability. Additionally, the study highlighted the role of legitimate health systems in practising civic virtue and promoting social justice, thus contributing to peace-building efforts. These insights are crucial for policymakers and development donors to strengthen health systems in challenging contexts.