ReBUILD
ReBUILD for Resilience: Health System Resilience in Fragile Settings Experiencing Violence, Conflict, Pandemics and Other Shocks
Co-led and co-designed by IGHD at Queen Margaret University, ReBUILD for Resilience is an international consortium of organisations from Lebanon, Myanmar, Nepal, Sierra Leone and the UK. Between us we have expertise across all health systems pillars and in a wide range of disciplines including public health, epidemiology, social sciences, health economics, political science, research methodologies and gender.
The consortium is building on the work started during the highly successful ReBUILD programme but is focusing on a wider range of stressors in a wider range of contexts – fragile and shock-prone (FASP) settings.
The consortium has been active since 2020 and is funded by a £7.68 million grant from the UK government’s Foreign, Commonwealth and Development Office.
The ReBUILD for Resilience partners are: American University of Beirut (Lebanon); Burnet Institute (Myanmar); Institute for Development (Sierra Leone); Herd International (Nepal); and Liverpool School of Tropical Medicine (UK).
IGHD brings a wide range of expertise to ReBUILD for Resilience, including on health financing and economics, health system dynamic modelling, evaluation of complex interventions, participatory action research, impact evaluation, political economy and health policy analysis, and systematic reviewing. In addition to supporting a wide range of projects, IGHD currently leads four key Responsive Fund projects:
- Cultivating inclusive, coordinated networks between climate stakeholders in Bangladesh to enhance health system and community resilience to climate shocks and stressors
- Taking the long view: What can we learn about health system resilience in fragile contexts from Afghanistan (1989-2024)?
- Health System Resilience in Ethiopia's Tigray Region
- The role of the diaspora in supporting health system resilience in fragile and shock-prone settings
For information on the full range of ReBUILD projects, refer to the main ReBUILD Consortium website
- IGHD-Supported Projects
- Project Publications
- Podcasts
- Recent Presentations
- Blogs
- Improving the engagement of global health initiatives with country health systems, including in fragile and shock-prone settings
- Community stressors and coping mechanisms in accessing the health system during a double crisis: a qualitative case study from Yangon Region, Myanmar
- Liminal health systems: health seeking behaviour of migrants and internally displaced people from Myanmar along the Thailand-Myanmar border
- Embedding Social Network Analysis in Health Systems Resilience Research
- Strategies to support community health workers working in fragile urban contexts: a case study of the anglophone regions in Cameroon
- Cross-country learning on health system resilience: synthesis of OPM findings on the role of community health workers in COVID-19 and on governance for health system responses to emergencies
- Understanding health system resilience to respond to COVID-19 in a federalised context: a case study of health workforce management at sub-national level in Nepal
- Health system resilience amid outbreaks: understanding the politics of sexual and reproductive health service adaptation in eastern Democratic Republic of Congo
- Implementation of the reproductive, maternal, newborn, child and adolescent health policy in Sierra Leone: dynamics, challenges, and opportunities faced by policy implementers at the national and sub-national levels
- Exploring approaches for complementary private sector engagement in the health sector in Northern Syria
- The role of the diaspora in supporting health system resilience in fragile and shock-prone settings
- Taking the long view: What can we learn about health system resilience in fragile contexts from Afghanistan (1989-2024)?
- Young people’s mental health and psychosocial wellbeing in a fragile setting: formative research to strengthen community mental health systems in Myanmar
- Strengthening subnational health systems through support to public procurement and financial management: lessons from a technical assistance programme in Nepal
- The role of non-state actors in health service delivery and health system resilience in Myanmar (2015-22)
- Cultivating inclusive, coordinated networks between climate stakeholders in Bangladesh to enhance health system and community resilience to climate shocks and stressors
- Health system resilience in Ethiopia’s Tigray region
- Strategies to support community health workers working in fragile urban contexts: a case study of the anglophone regions in Cameroon
- Working with community leaders to address shocks, increase inclusivity, accountability and trust, and support health system resilience in Sierra Leone
- Community and health system stressors and coping mechanisms during COVID 19: case study from Myanmar
- Political economy, health financing and the role of shocks: case studies in Nepal and Thailand
- Disaster-resilient public financial management– webinar and brief
- Bringing political economy thinking into global health financing policy and practice in fragile and shock-prone settings
- Understanding and strengthening local health governance and planning to build resilient local health systems that leave no one behind: Nepal
For QMU's full partner profile, visit ReBuild's website.
2024 - Academic paper - Tequare, M., Bertone, M., Gebreslassie, F., Witter, S. (2024) Understanding health system resilience to inform recovery planning in Ethiopia's Tigray region. East African Journal of Health Sciences 6 (2) 2024.
2024 - Academic paper - Witter, S., et al. (2024) Potential and pitfalls of learning sites for health systems research: reflections from five programmes in Africa, Asia and Central America. Learning Health Systems, e10475.
2024 - Academic paper - Goodman, C., Witter, S., Hellowell, M. et al. (2024) Approaches, enablers and barriers to govern the private sector in health in low- and middle- income countries: a scoping review. BMJ Global Health 0:e015771. doi:10.1136/bmjgh-2024-015771.
2024 - Academic paper - Than, K., Bertone, M. P., La, T., & Witter, S. (2024). Assessing the role of non-state actors in health service delivery and health system resilience in Myanmar. International Journal for Equity in Health, 23(1), 221.
2024 - Policy paper - Witter, S., & Baker, P. (2024). Tracking Delivery on the Lusaka Agenda (No. 336). Center for Global Development.
2024 - Academic paper - Fortnam, M., Hailey, P., Witter, S., & Balfour, N. (2024). Resilience in interconnected community and formal health (and connected) systems. SSM-Health Systems, 3, 100027.
2023 - Academic paper - Witter, S., Diaconu, K., Bou-Orm, I., Jamal, Z., Schroff, Z., Mahmoud, A., Daher, M., Varma, V. (2023) Evolution and lessons from an integrated service delivery network in North West Syria. Conflict and Health, 17:12.
2023 - Academic paper - Bertone, M., Palmer, N., Kruja, K., Witter, S. (2023) How do we design and evaluate health system strengthening? Collaborative development of a set health system process goals. International Journal of Health Planning and Management, 38, 2.
2023 - Academic paper - Regmi, S., Bertone, M., Shrestha, P., Sapkota, S., Arjyal, A., Martineau, T., Raven, J., Witter, S., Baral, S. (2023) Understanding Health System Resilience in responding to a pandemic: experience and lessons from an evolving context of federalization in Nepal. Forthcoming with BMC Health Services Research.
2023 - Academic paper - Witter, S., Thomas, S., Topp, S., Barasa, E., Chopra, M., Cobos, D., Blanchet, K., Teddy, G., Atun, R., Ager, A. (2023) Health system resilience: a critical review and reconceptualisation. Lancet Global Health, 11, 9, e1454-e1458.
2023 - Academic paper - Kyaw, H.K., Than, K. K., Diaconu, K., Witter, S. (2023) Community and health system stressors and coping mechanisms during a double crisis: a qualitative case study from Myanmar. International Journal for Equity in Health, 22:39.
2022 - Academic paper - Gooding, K., Bertone, M., Loffreda, G., Witter, S. (2022) How can we strengthen partnership and coordination for health system emergency preparedness and response? Findings from a synthesis of experience across countries facing shocks. BMC Health Services Research special edition on resilience, 22:1441.
2022 - Academic paper - Witter, S., Sheikh, K., Schleiff, M. (2022) Learning health systems in low-income and middle-income countries: exploring evidence and expert insights. BMJ Global Health 2022; 7e008115; special edition on learning health systems.
2022 - Academic paper - Diaconu, K., Witter, S., Binyaruka, P., Borghi, J., Brown, GW., Singh, N., Herrera, CA. (2022) Appraising pay-for-performance in healthcare in low- and middle-income countries through systematic reviews: reflections from two teams. Cochrane Database of Systematic Reviews, Issue 4. Art. No: ED000157.
2021 - Academic paper - Lin, T., Werner, K., Witter, S., Alluhidan, M., Alghaith, Hamza, M., Herbst, C. (2021) Individual performance-based incentives for health care workers in Organisation for Economic Co-Operation and Development member countries: a systematic literature review. Health Policy.
2021 - Academic paper - Witter, S., Bertone, M., Diaconu, K., Bornemisza, O. (2021) Performance-based financing - false dichotomy? Health Systems & Reform, vol. 7, no. 1.
2021 - Academic paper - Diaconu, K., Falconer, J., Verbel-Facuseh, A., Fretheim, A., Witter, S. (2021) Paying for performance to improve the delivery of health interventions in low- and middle-income countries. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD007899.
2020 - Academic paper - Vijayasingham, L., Govender, V., Witter, S., Remme, M. (2020) Employment-based health financing does not support gender equity in Universal Health Coverage. British Medical Journal; 371: m3384.
2020 - Policy paper - Jacobs, E., Bertone, M., Toonen, J., Akwataghibe, N., Witter, S. (2020) Integration of performance based financing within health financing policies: an analysis of fragile and conflict-affected settings. Applied Health and Economics and Health Policy.
2020 - Academic paper - Witter, S., Chirwa, Y., Chandiwana, P., Munyati, S., Pepukai, M., Bertone, M., Banda, S. (2020) Results-based financing as a strategic purchasing intervention: what can we learn from the experience of Zimbabwe? BMC Health Services Research, 20: 180.
2020 - Academic paper - Diaconu, K., Falconer, J., Vidal, N., Azasi, E., Sarb, C., O'May, F., Elimian, K., Bou-Orm, I., Witter, S., Ager, A. (2020) Understanding fragility: implications for global health research and practice. Health Policy and Planning, 2020 Mar 1;35 (2): 235-243.
2020 - Academic paper - Jamal, Z., Alameddine, M., Diaconu, K., Lough, G., Witter, S., Ager, A., Fouad, F. (2020) Health system resilience in the face of crisis: analyzing the challenges, strategies and capacities for UNRWA in Syria. Health Policy and Planning, 13, 1, p. 26-35.
2019 - Academic paper - Witter, S., Chirwa, Y., Chadiwana, P., Munyati, S., Pepukai, M., Bertone, M. (2019) The political economy of results-based financing: the experience of the health system in Zimbabwe. Global Health Research and Policy, 4.
July 2019 - Academic paper - Witter, S., Palmer, N., Balabanova, D., Mounier-Jack, S., Martineau, T., Klicpera, A., Jensen, C., Pugliese-Garcia, M. and Gilson, L. (2019) Health system strengthening-Reflections on its meaning, assessment, and our state of knowledge International Journal of Health Planning and Management, 34(4). Read this paper
February 2019 - Research Summary - This summary document gives an overview of the projects and research themes which have made up ReBUILD’s work, with links to all of ReBUILD’s theme-specific resources lists and complete published outputs online. See this summary over on the ReBUILD website
January 2019 - Academic paper - Witter, S., Bertone, M.P., Namakula, J., Chandiwana, P., Chirwa, Y., Ssenvonio, A., and Ssengoobe, F. (2019) (How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo Global Health Research and Policy, 4(3). Read this paper
January 2019 - Blog (French language) - Prof Sophie Witter, Systèmes de santé fragiles et affectés par les conflits: réduire la fracture linguistique. Read this Blog
December 2018 - Briefing papers (French language) - French versions of the briefing papers which were produced earlier in the project. They address key questions on health systems strengthening in settings affected by conflict or crisis. Read the papers over on the ReBUILD website
November 2018 - Academic paper - Bertone, M. P., Martins, J. S., Pereira, S. M., Martineau, T., and Alonso-Garbayo, A. (2018) Understanding HRH recruitment in post-conflict settings: an analysis of central-level policies and processes in Timor-Leste (1999–2018) Human Resources for Health, 16 (66). Read this Paper
October 2018 - Webinar - Performance based financing in fragile and conflict-affected settings: from research to practice. 31 October 2018.
October 2018 - Academic Paper - Bertone, M. P., Wurie, H., Samai, M., Witter, S. (2018) The bumpy trajectory of performance-based financing for healthcare in Sierra Leone: agency, structure and frames shaping the policy process. Globalisation and Health, 14 (99). Read this Paper
September 2018 - Briefing paper - a briefing paper which summarises ReBUILD's work towards performance-based financing (PBF) in fragile and conflict-affected states. Read the paper over on the ReBUILD website
June 2017 and July 2018 - Briefing papers - 9 briefing papers have been produced which address key questions on health systems strengthening in settings affected by conflict or crisis. Read the papers over on the ReBUILD website
June 2018 - Academic Paper - Bertone, Maria Paola and Jacobs, Eelco and Toonen, Jurrien and Akwataghibe, Ngozi and Witter, Sophie (2018) Performance-based financing in three humanitarian settings: principles and pragmatism. Conflict and Health, 12 (28). ISSN 1752-1505 Read this Paper
May 2018 – Academic Paper - Raven, Joanna and Wurie, Haja and Witter, Sophie (2018) Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study. BMC Health Services Research, 18 (1). p. 251. ISSN 1472-6963 Read this Paper
April 2018 – Academic Paper - Bertone, Maria Paola and Falisse, J-B and Russo, Giuliano and Witter, Sophie (2018) Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems. PLOS ONE, 13 (4). e0195301. ISSN 1932-6203 Read this Paper
February 2018 – Academic Paper - Raven, Joanna and Baral, Sushil and Wurie, Haja and Witter, Sophie and Samai, Mohamed and Paudel, Pravin and Subedi, Hom Nath and Martineau, Tim and Elsey, Helen and Theobald, Sally (2018) What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal. Health Research Policy and Systems, 16 (6). ISSN 1478-4505 Read this Paper
January 2018 – Academic Paper - Witter, Sophie and Wurie, Haja and Namakula, Justine and Mashange, Wilson and Chirwa, Yotamu and Alonso-Garbayo, Alvaro (2018) Why do people become health workers? Analysis from life histories in 4 post-conflict and post-crisis countries. The International Journal of Health Planning and Management, 33 (2). pp. 449-459. ISSN 0749-6753 Read this Paper
January 2018 – Academic Paper - Witter, Sophie and Brikci, Nouria and Harris, Tim and Williams, Richard and Keen, Sarah and Mujica, Ana and Jones, Alex and Murray-Zmijewski, Alex and Bale, Barbara and Leigh, Bailah and Renner, Ade (2018) The free healthcare initiative in Sierra Leone: Evaluating a health system reform, 2010-2015. The International Journal of Health Planning and Management, 33 (2). pp. 434-448. ISSN 0749-6753 Read this Paper
December 2017 – Academic Paper - Witter, Sophie and Namakula, Justine and Wurie, Haja and Chirwa, Yotamu and So, Sovanarith and Vong, Sreytouch and Ros, Bandeth and Buzuzi, Stephen and Theobald, Sally (2017) The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts. Health Policy and Planning, 32 (supp_5). v52-v62. ISSN 0268-1080 Read this Paper
November 2017 – Academic Paper - Witter, Sophie and Wurie, Haja and Chandiwana, Pamela and Namakula, Justine and So, Sovannarith and Alonso-Garbayo, Alvaro and Ssengooba, Freddie and Raven, Joanna (2017) How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda, Sierra Leone, Zimbabwe and Cambodia. Health Policy and Planning, 32. (Suppl_3). iii3-iii13. ISSN 0268-1080 Read this Paper
October 2017 – Academic Paper - Ros, Bandeth and Lê, Gillian and McPake, Barbara and Fustukian, Suzanne (2017) The commercialization of traditional medicine in modern Cambodia. Health policy and planning, 33 (1). pp. 9-16. ISSN 1460-2237 Read this Paper
July 2017 – Academic Paper - Martineau, Tim and McPake, Barbara and Theobald, Sally and Raven, Joanna and Ensor, Tim and Fustukian, Suzanne and Ssengooba, Freddie and Chirwa, Yotamu and Vong, Sreytouch and Wurie, Haja and Hooton, Nick and Witter, Sophie (2017) Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states. BMJ Global Health, 2 (2). e000327. ISSN 2059-7908 Read this Paper
June 2017 – Academic Paper - Ssengooba, Freddie and Kawooya, Vincent and Namakula, Justine and Fustukian, Suzanne (2017) Application of social network analysis in the assessment of organization infrastructure for service delivery: a three district case study from post-conflict northern Uganda. Health Policy and Planning, 32 (8). pp. 1193-1202. ISSN 0268-1080 Read this Paper
June 2017 – Academic Paper - Ssengooba, Freddie and Namakula, Justine and Kawooya, Vincent and Fustukian, Suzanne (2017) Sub-national assessment of aid effectiveness: A case study of post-conflict districts in Uganda. Globalization and Health, 13 (1). ISSN 1744-8603 Read this Paper
January 2017 – Academic Paper - Witter, Sophie and Bertone, Maria Paola and Chirwa, Yotamu and Namakula, Justine and So, Sovannarith and Wurie, Haja R. (2017) Evolution of policies on human resources for health: opportunities and constraints in four post-conflict and post-crisis settings. Conflict and Health, 10 (1). ISSN 1752-1505 Read this Paper
Several of our QMU team members have been involved in the ReBUILD podcast series - Stories of Resilience – Local Lives and Health Systems.
- Episode 1: Revisiting resilience in health systems research
- Episode 4: Non-state and informal actors in fragile settings
- Episode 6: Health system financing in fragile settings
- Towards a typology of financial autonomy of primary healthcare facilities in LMICs
- Health system resilience in Ethiopia’s Tigray region: preliminary document review findings
- Reimagining the future of the global health initiatives (panel organiser and chair), Health Systems Global Nagasaki, November 2024
- Presented an exploratory review of financial autonomy at primary care level at the Montreux Collaboration meeting on PFM and health, November 2023.
- Presented findings on the Future of Global Health Initiatives research, 24th August 2023.
- Speaker at ‘Co-shaping global health: institutional solutions’, Blavatnik School of Government, Oxford, 23rd March 2023.
- Organiser and chair, ReBUILD Webinar on disaster-resilient PFM – what it is and implications for the public health sector? November 2022.
- Organiser and chair of ‘Health System Resilience - Framing debates and latest evidence as we start to emerge from the COVID-19 pandemic’, ReBUILD and SYSTAC, 7th June 2022.
- Presentation on direct facility payments, 5th Montreux meeting on public financial management, 17th November 2021.
- Pop up webinar on performance-based financing for health care in LMICs for Cochrane, June 2021
- Presenting on family planning, UHC and equity in ‘Putting the “Universal” into “UHC Schemes” for Family Planning’, Thinkwell webinar series, 3rd June 2021.
- Presenting on learning health systems and social accountability, VAPAR webinar for HSG, ‘Voice needs bite to have teeth’ 2nd June 2021.
- Organised and presented at webinar on health system strengthening: Getting on the same page. May 19th 2021.
- Presented evidence on PBF and direct facility financing to Health Financing Accelerator group, 2nd March, 2021
- Presented updated Cochrane review of pay for performance in LMICs, World Bank RBF workshop, 26th February 2021
- Presenter and panellist on ‘Fostering learning health systems in low and middle-income countries’, organised by the AHPSR for HSG conference, January 2021
- Raven, Witter et al. Solidarity and psychosocial support: Healthcare workers on World Mental Health Day, 10th October 2020.
- Organiser, facilitator and presenter of FCDO learning journey on ‘Health financing priorities in the time of COVID-19’, 12th October 2020.
- Presented on health financing and refugees, UNHCR annual workshop, November 2020.
- Presented on health system strengthening and international partnerships, THET conference, September 2020
- Presented ‘What works for health system strengthening, where and when?’ at the Department for International Development, London, 30th July 2019. Video version here.
- Sparkes, S., Barroy, H., Chalkidou, K., Baker, P. and Witter, S. (2025) Money Talks: Lusaka Agenda Financing Alignment Indicators. CGD blog.
- Diaconu, K. (2024) Why the focus on health system resilience? Isn't it the shocks we should be addressing?
- Ravishankar, N., Barasa, E., Witter, S., Nakyanzi, A. and Kutzin, K. (15 November 2023) Learning from the past: A systems approach to facility financing reforms. BMJ Global health blog.
- Witter, S. Supporting health system resilience – if not now, when? UHC Day 2020 blog.
The following QMU staff members contribute to the ReBUILD project: Sophie Witter; Maria Bertone; Karin Diaconu; Mariel Horncastle; Natasha Palmer; Arek Dakessian; and Paul Kadetz.
IGHD Project Enquiries
We welcome enquiries relating to current and prospective research.
See panel at the bottom of the page for all staff involved in this project.
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