Research for stronger health systems during and after crisis

Health Financing in Fragile and Conflict-Affected States: Controversies and Innovations


Date: October 8th 2018


Video recordings of presentations from this session are available here. Both are by Professor Sophie Witter of Queen Margaret University, UK and the ReBUILD Consortium:

About the session

This session will discuss challenges and opportunities to improve health financing in fragile and conflict-affected states (FCAS), ensuring access to prioritised health services with financial protection, particularly for the most vulnerable, and where typical health system strengthening approaches have failed. The number of people who are estimated to live in such fragile contexts is projected to grow to 1.9 billion by 2030.  The number of people who are internally displaced or have become refugees is the highest since World War II.

This session will focus on the latest thinking and evidence-base on challenges and options for health financing in fragile states, covering resource generation, pooling, purchasing and benefits packages. Weak national capacity to deliver basic health and social services, coupled with poor financial management systems, present the biggest challenge to current and future achievements in health in fragile and conflict settings. The overall approach to health financing in humanitarian contexts is often short-term, with limited interaction and exchange among technical agencies supporting a humanitarian response, and those supporting longer-term development. Contracting and performance-based financing (PBF) are being widely used in post-conflict situations, although the evidence is not robust in terms of their costs of implementation and impact. When fragility increases, traditional development support often withdraws, and if humanitarian funding decreases, the default financing option still relies on out-of-pocket payments.

During the session, the evidence base will be presented for the effectiveness of various approaches to improve the financing functions to effectively finance services in a coordinated manner, and experiences will be shared by country partners. The session will cover the following topics:

  • Results of a review of the current state of knowledge and practice of health financing in fragile states, exploring the need to adapt options for different contexts and strengthen capacities.

  • Challenges of financing an essential package of health services (EPHS) in Afghanistan, including the pooling of funds, contract management, strategic purchasing of services, and the impact on health.

  • Pros and cons of performance-based financing, and the reasons why it is so common in these types of environments.

  • Challenges around humanitarian financing, including the design and funding of services for refugees and internally displaced people, and coordination of the humanitarian and development community in the humanitarian-development nexus.



1:30-2pm- Introduction


2-2:45pm  Panel 1 – Health financing in Afghanistan: 15 years of purchasing a health benefits package

  • Overview: Egbert Sondorp, KIT Royal Tropical Institute

  • Panel discussion: MoPH (Minister); World Bank; contracted NGO

  • Discussion


3:15-4pm  Panel 2 – Performance-based financing as a way to build strategic purchasing in FCAS: potential and pitfalls


4-4:45pm   Panel 3 – Innovations in Humanitarian Financing: what else can be done to fill the financing gaps?  

  • Overview of innovative financing options – Paul Spiegel, Johns Hopkins University

  • Practices in addressing the health needs of refugees and internally displaced population groups:  Experience from Uganda and Northern Nigeria – Grace Kabaniha, WHO

  • Is giving money to people good value for money to achieve health outcomes and ensure access to essential health services?: cash transfer programming for health in humanitarian contexts: Andre Griekspoor, WHO

  • Forward to the past, and repeating old mistakes as the default for filling the financing gap? Re-emerging user fees in FCAS: Mitt Phillips, MSF

4:45-5pm - Discussion and wrap-up


Who is the session aimed at?

The target audience includes policy makers, planners, managers and academics from both the development and humanitarian communities with an interest in addressing the challenges of health financing for service delivery in FCAS states.


Who is the session supported by?

World Health Organization; Global Fund to Fight AIDS, Tuberculosis & Malaria; KIT Royal Tropical Institute; and the ReBUILD Consortium.

Organised in collaboration with the HSG Thematic Working Group on Fragile and Conflict-Affected States.