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Table 3 Summary of implications of conflict and fragility for the health systems

From: Performance-based financing in three humanitarian settings: principles and pragmatism

  South Kivu / DR Congo Central African Republic Adamawa State / Nigeria
National governance and leadership • Conflict exacerbated pre-existing weaknesses related to lack of governance and underfunding • MoH lost its leadership role to donors and NGOs • Structured federal system with effective decentralisation
• Federal and state governments’ efforts to strengthen primary health care delivery
Consequences of conflict on service delivery • Violent episodes have left infrastructure destroyed, equipment pillaged and led to lack of staff in some areas • By 2016 27% of health facilities were partially or fully destroyed, and of all functioning facilities only 22% had a source of energy and 43% running water • Insurgency left only 37% of facilities functional with limited staff, a break-down in governance and facing disease outbreaks
Healthcare financing • No fee exemption policies (except for some vertically-funded preventative services)
• Reliance on user fees and external interventions
• Since 2014, externally funded free healthcare policy for women (covering perinatal services), children and ‘emergency’ services • User fees in place generally, though lifted at the height of the crisis in 2014