THEMATIC AREA
Health systems in humanitarian contexts
Humanitarian health responses always intervene within a pre-existing health system, generally fragile or damaged. This open-access learning resource analyses its main conceptual frameworks and examines in depth how the WHO health system building blocks (service delivery, workforce, financing, governance, medicines, and information) are affected in humanitarian crises and how they can be supported. You will find AI-assisted reflection exercises on each page and a case study at the end.
7
pages
What is a healthcare system? How does it work and what are its components?
Humanitarian and development health interventions do not occur in a vacuum. They take place in real contexts where a health system already exists, better or worse, with greater or lesser capacity. Depending on how we act, we can weaken it, contribute to its resilience at a critical moment, or even help strengthen it in a sustainable way. To have a positive effect on health systems through international cooperation, we must understand what health systems are and how certain conceptual frameworks can help us analyse a specific health system.
This first page introduces the main reference models and conceptual frameworks: from the classic WHO six building blocks framework to more modern approaches that focus on quality or resilience in humanitarian crises. Understood and used in combination, these frameworks will help us identify strengths, weaknesses, and intervention priorities.
- The 2007 WHO framework defines six core components of every health system: service delivery, health workforce, information, medicines and supplies, financing, and governance. Strengthening them requires understanding the interactions between them.
- The World Bank's "control knobs" model proposes five health system elements to act upon: financing, payment, organisation, regulation, and behaviour.
- Kruk's health system quality model focuses on effectiveness, safety, and timely responsiveness, as well as the trust of the people who use it.
- Blanchet's health system resilience framework focuses on the capacity to absorb shocks, adapt, and transform in the context of conflicts, pandemics, and emergencies.
10-minute read + 1 AI-assisted reflection question
→ Read more.
What are the 6 building blocks of a health system according to the WHO, and how can they be sustained in humanitarian crises?
As we have already seen, the WHO six building blocks framework is not the only reference model for understanding health systems, but it is the most widely used. We can thus deepen our study of health systems in humanitarian crises by analysing their six pillars: service delivery, health workforce, financing, medicines and supplies, information systems, and governance.
These pillars are deeply interconnected. Governance or system financing determines the incentives for health workers or access to medicines, and the information system tells us whether all of this is functioning and has an impact on the quality and availability of services. If one pillar collapses, it affects the others. The six pages in this section analyse each pillar: how each one is defined, how it is damaged in a humanitarian crisis, and what international cooperation can do to sustain it.
- Good service delivery is defined by its comprehensiveness, accessibility, coverage, continuity, quality, and people-centredness.
- In humanitarian crises, these six attributes deteriorate. Therefore, new essential service packages and temporary provision modalities, such as mobile medical teams, may be necessary.
- Evaluating existing health services is the starting point for any health humanitarian intervention. There are tools that allow us to map their availability and functional capacity, but we must never ignore the opinions of the users, who are rights holders.
12-minute read + 1 AI-assisted reflection question
→ Read more.
- Health system financing has three key sub-functions: revenue collection, pooling, and purchasing of goods and services. The equity of the system and the financial protection of the population depend on their management and performance.
- Systems based on prepayment and public investment are more equitable and efficient than those based on out-of-pocket payments, which penalise those with the fewest resources.
- Humanitarian action can help ensure that essential health services are free and accessible to all people affected by an emergency.
- Cash transfers can help cover indirect costs of healthcare, but cannot substitute for the direct financing of health services.
11-minute read + 1 AI-assisted reflection question
→ Read more.
- Health system governance encompasses the functions of regulation, accountability, coordination, and leadership, which are used to guide all public and private actors towards the protection of the public interest and the right to health.
- Governance does not rest solely with the Ministry of Health and other authorities; service providers, civil society, and international actors also play key roles within it.
- In conflicts and complex humanitarian crises, health system governance becomes fragmented and multipolar, with new actors lacking formal political power taking on stewardship functions. Humanitarian action must map these actors and operate through advocacy, technical assistance, or support for citizen participation.
8-minute read + 1 AI-assisted reflection question
→ Read more.
- In 2020, a global shortage of 15 million health professionals was estimated, concentrated primarily in Africa and in the most fragile states.
- In humanitarian crises, when health workers are scarce or forced to flee, tasks are delegated to staff with less training and experience, who require support and supervision.
- The recovery of the health workforce after the acute emergency requires policies and interventions that address incentives, certification, continuous training, and intersectoral coordination.
6-minute read + 1 AI-assisted reflection question
→ Read more.
- More than two billion people lack access to the medicines they need. The supply chain is fragile in humanitarian crises, and there are additional risks of counterfeit or substandard medicines circulating.
- In low-income countries, more than half of the medicines that are prescribed are not freely available in health facilities, forcing people to purchase them outside at prohibitive prices.
- In humanitarian emergencies, medical supply kits are used to facilitate the initial response, but estimating needs beyond the first few months requires careful management.
- Antimicrobial resistance is a problem exacerbated by limited access to services, regulatory weakness, inappropriate prescribing, and lack of diagnostic capacity.
10-minute read + 1 AI-assisted reflection question
→ Read more.
- A health information system has three objectives: to generate information on population health and health system performance, to detect public health threats, and to transform data into actionable knowledge for decision-making.
- Its components include human resources, technologies, indicators, data sources, and mechanisms for information management, analysis, and dissemination.
- In humanitarian crises, the health information system can collapse or become fragmented. Maintaining minimal epidemiological surveillance or calculating reliable crude mortality rates become genuine challenges.
8-minute read + 1 AI-assisted reflection question
→ Read more.
Case study: health system support, strengthening, and resilience
Have you read all the pages? Well, I propose an exercise for you to put your knowledge into practice. It consists of a case study with a series of questions. Once you've answered them, press the button for NotebookLM to open. Paste the content of your clipboard there (Ctrl+V on Windows, Command+V on Mac) to get feedback.
🧠 Case study
The armed conflict in the imaginary country X lasted twelve years. During that time, several humanitarian organisations sustained the most basic health services in the most affected areas: they paid incentives to health workers who stayed, trained community health workers to cover basic diagnostic and treatment functions, imported and supplied essential medical products, and repaired some damaged infrastructure in priority health facilities.
Eight months ago, a peace agreement was signed. Direct violence has almost completely ceased in most of the areas where you work, though political instability persists and there is a real risk of the conflict reigniting. The Ministry of Health is gradually resuming its functions, but with very limited capacity. It can barely pay the salaries of public sector health workers, the health information system is fragmented across multiple actors, and system governance is weak and contested in some areas between national authorities and local structures that gained influence during the conflict.
An international donor has just approved a funding call for three-year projects. It sets as its objective going beyond the maintenance of basic services and advancing towards health system strengthening and resilience. Your organisation must design a project proposal.
1. In your view, which two or three health system building blocks most urgently need intervention at this moment of transition? Why those and not others?
2. The interventions from the previous phase were necessary during the emergency. Which of them make sense to continue, transform, or abandon in this new phase? Why?
3. The donor speaks of strengthening the health system's resilience. What does that mean in practice in this context, and what concrete interventions do you propose?
4. Governance of the system is contested in some areas. How do you decide which authorities to work with, and how do you do so without compromising humanitarian principles or the sustainability of the interventions?
- Think and write your answer.
- Click on «Copy and open».
- Paste to receive feedback.
📚 This is the NotebookLM of this learning pathway. It uses only carefully selected references. | What is NotebookLM?
Clearly, the topic of health systems in humanitarian contexts is closely related to other health issues, such as universal health coverage, primary care and community health, or the way of understanding global health and humanitarian health. In some contexts, specific health needs also require attention, such as sexual and reproductive health, nutrition, or epidemic control and response. Staff working in this field must have a solid grounding in their core competencies, which are not limited to the technical but also include key issues such as humanitarian principles and the dilemmas that arise in their application.