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

Sumona Chaudhury, MD, MPH, ScD, Miranda McKinley Ravicz, MD, Heather McPherson, Lauren Arlington, MPH, Tianyu Lin, BA, BS, Jessica Turco, MEd, BA, BS, Brett D. Nelson, MD, MPH, DTM&H


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 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 postconflict settings and a range of terms related to PHC or health system development. Search terms were selected by careful review of the World Health Organizations 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.


primary healthcare, conflict-affected, health system development, scoping review

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