Delivering primary healthcare in conflict-affected settings: A review of the literature

Abstract

Objective: Conflict is often destructive to existing services and exacerbates population health inequities and the vulnerabilities of existing healthcare. We undertook a scoping review of the literature concerning delivery of primary healthcare (PHC) in post-conflict settings. Design: We undertook a scoping review of the peer-reviewed and gray literature to identify articles related to the development and delivery of PHC in post-conflict settings. We searched PubMed/Medline, Cochrane Library, Embase/Ovid, CAB abstracts, POPLINE, and WHO.int. between January 1990 through the December end of 2017, for articles in the English language. Two researchers independently assessed each article and applied inclusion criteria: referring to post-conflict settings and a range of terms related to PHC or health system development. Search terms were selected by careful review of the World Health Organization’s analytical framework for developing a strategy on universal coverage and analysis according to the availability, accessibility, affordability, and acceptability of healthcare and further themes involving demand-side or user-side concerns. Results: Findings were captured to reflect a range of conflict-affected settings and varied priorities and approaches to PHC reconstruction. Integrated immediate and longer-term strategies, involving needs-assessments, effective administration, development of institutions, and cost-efficient investment in human resources, infrastructure, and capacity building are needed to deliver expanded and equitable services, responsive to population health needs, critical to the delivery of equitable PHC. Conclusions: Scoping review of the literature may be formative in the generation of evidence-base to inform delivery of universal PHC, when applied according to context specificity of conflict-affected setting.