Research for stronger health systems during and after crisis


The ReBUILD Consortium was an international health systems research partnership, funded by the UK Department for International Development (now Foreign, Commonwealth and Development Office), which addressed the previously neglected area of health systems research in fragile and conflict-affected states (FCAS). From 2011 to early 2019, ReBUILD produced a large body of original research on issues including health financing design in FCAS, health workforce incentives and organisation post conflict, health systems resilience, gender equitable health systems, and aid effectiveness. The aim was to support evidence-based policy and practice for improved access of the poor to effective health care and to reduce health costs burdens in settings affected by conflict and crisis. ReBUILD became a source of leading expertise in this field, establishing rich partnerships with research collaborators, policy makers, international organisations and networks.

ReBUILD was made up of partner organisations in the UK, Sierra Leone, Uganda, Cambodia, Zimbabwe, Timor Leste, with the research focusing on these and other settings which have been affected by political and social conflict. 

Supporting health and development goals

About 25% of the world’s population lives in fragile and conflict-affected settings, but the proportion of the world’s poor living in these settings is much larger and is growing, projected to reach over 60% by 2030.[1] Addressing health needs in these settings is critically important: for example 60% of the world’s maternal deaths[2] and 60% of the world’s children who die before the age of 5[3] live in fragile settings. And health systems are severely affected by conflict, which disrupts the balance and relationships between the supply of health care services and their ability to meet the health needs and demands of the population.

Decisions made in the early post-conflict period can set the long-term direction of development for the health system. In post-conflict settings, effective health systems can contribute to peace building by: supporting the legitimacy of government, strengthening the population‘s stake in peace and bridging communities.

ReBUILD’s research and outputs

ReBUILD’s research from 2011 to 2016 predominantly focused on the post-conflict settings of Cambodia, Sierra Leone, Uganda and Zimbabwe, working with national partners in these countries. The thematic and geographical scope of this work was complemented both through affiliate partners’ research and by further core research from 2017 to 2019, to include Timor Leste, the Democratic Republic of Congo, Sri Lanka, Liberia, Gaza, Côte d’Ivoire, Nigeria, South Africa and Central African Republic.

The research themes and projects are described in detail on this website, and all outputs from the programme available through the searchable resources page, and via a summary research and outputs list.

As well as its original research, ReBUILD produced a number of synthesis briefing papers drawing on wider research, to inform specific health systems challenges in conflict and crisis-affected settings.

Research into policy and practice

Ensuring that the knowledge that the research generates is useful to decision makers and practitioners was crucial to this work. ReBUILD's partners were actively working throughout the programme with a wide array of stakeholders from government, academia, donor organisations, professional bodies and civil society to ensure that the research contributes to real change that makes a significant impact for the lives of the world's most vulnerable populations.


[1] OECD (2015) States of Fragility 2015 – Meeting post-2015 ambitions, OECD Publishing, Paris.

[2] UNFPA (2015) Maternal mortality in humanitarian crises and in fragile settings. Statistics brief, UNFPA.

[3] OECD (2018), States of Fragility 2018, OECD Publishing, Paris