21 January 2020

Applying a Health Systems Assessment in a fragile setting.

Yemen: a multi-stakeholder approach to rebuilding the health system

The humanitarian crisis in Yemen is the worst in the world, driven by conflict, economic collapse and the continuous breakdown of public institutions and services. More than 24.1 million people are in need of humanitarian aid; 7.4 million people or nearly a quarter of the entire population are malnourished; and more than 3.34 million people are internally displaced. The conflict that started in 2015  and the crisis that followed has gravely affected the already debilitated health system, leaving around 49% of health facilities partially functioning or non-functioning due to damage, with shortages in staff, medicines, fuel and other critical supplies. All this makes access to health services extremely challenging.

In June 2019, the UHC2030 Technical Working Group on UHC in Fragile Settings published a Guidance Document on Assessing a Health Care Arena under Stress. The aim of the document is to support professionals who are, or plan to be, involved in carrying out a Health Systems Assessment (HSA) in a fragile setting. It is designed in a way that the assessment processes and findings can inform health systems strengthening approaches when and where opportunities arise. It can be applied as an aid in early recovery approaches in humanitarian responses as well as to improve preparedness. It should, where possible, be coordinated under the leadership of the health authorities and other relevant stakeholders.

WHO, as a lead partner in the UHC2030 Technical Working Group on UHC in Fragile settings, is taking this approach forward in Yemen by testing and implementing the guidance.

On 23-24 September 2019, the Yemen Health System Analysis Consultative Meeting, organised by the World Health Organization, took place in Amman, Jordan bringing together a range of health stakeholders including: DFID, ECHO, WHO Head Quarters, Regional and Country Offices, EU, GIZ, IOM, Save the Children, UNICEF and USAID. Yemini professionals familiar with the health sector and the ongoing work of the Yemen Ministry of Public Health and Population took also part in the meeting.

The objectives of the meeting were to:

  • Initiate an inclusive process for a comprehensive health systems assessment for Yemen, and build consensus on its methodological approach.
  • Debate the main features of healthcare provision, as understood from the available information. Preliminary interpretations, patterns, trends, issues and key findings were discussed.
  • Identify the issues of interest requiring further exploration, and agree on the ways to fill such gaps.
  • Identify key stakeholders that need to be involved in the process and plan for their engagement.
  • Explore modalities for continued information sharing and joint analysis, with a view to promoting collaborative approaches and interventions.

During the workshop, colleagues shared valuable documents and presentations, selected for their relevance to the Yemen HSA. In this way, participants fostered a common understanding of what is needed to support Yemen’s efforts to rebuild the health system, demonstrating the mutual benefits of sharing knowledge in a multi-stakeholder context.

Follow up steps after the workshop include collecting and analysing data in relation to health system needs; reviewing and appraising possible collaborations for health systems interventions and fostering ownership of the process by national stakeholders; and reaching out to those health and other stakeholders who were absent at the first meeting. Ultimately, fostering a shared understanding of the healthcare arena and encouraging joint actions are positive moves for Yemen’s health system and the population who need better access to health services.

Photo credit: Omar Nasr, WHO

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