Health system governance assessment in protracted crisis settings: Northwest Syria

Health Research Policy and Systems

Research

Zedoun Al Zoubi¹  Maher Alaref²  Munzer Al Khalil³  Orwa Al-Abdulla⁴  Abdulkarim Ekzayez⁵ 

[1] Research for Health System Strengthening in Northern Syria (R4HSSS), Union for Medical and Relief Organizations, Incili Pinar MAH, 27090, Gaziantep, Turkey;Research for Health System Strengthening in Northern Syria (R4HSSS), Union for Medical and Relief Organizations, Incili Pinar MAH, 27090, Gaziantep, Turkey;Strategic Research Center (ÖZ SRC), Gaziantep, Turkey;Research for Health System Strengthening in Northern Syria (R4HSSS), Union for Medical and Relief Organizations, Incili Pinar MAH, 27090, Gaziantep, Turkey;Syria Public Health Network, London, UK;Strategic Research Center (ÖZ SRC), Gaziantep, Turkey;Syria Public Health Network, London, UK;The Centre for Conflict & Health Research (CCHR), King’s College London, London, UK;

关键词: Central bodies;    Conflict;    Crisis;    Governance;    Health system;    Syria;   

DOI  :  10.1186/s12961-023-01042-1

 received in 2023-05-15, accepted in 2023-08-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSince the withdrawal of government forces from Northwest Syria due to the conflict, several national initiatives have aimed to create alternative governance approaches to replace the central governmental system. One of the recent initiatives was the formulation of so-called ‘Central Bodies’ as institutional governance structures responsible for thematic planning and service provision; for example, the referral unit is responsible for planning and delivering medical referral services. However, the governance and administrative rules of procedures of these bodies could be immature or unsystematic. Assessing the governance of this approach cannot be condoned, especially with the urgent need for a methodical approach to strategic planning, achieving strategic humanitarian objectives, and efficiently utilizing available resources. Multiple governance assessment frameworks have been developed. However, none were created to be applied in protracted humanitarian settings. This research aims to assess the extent to which the existing health governance structure (central bodies) was capable of performing the governance functions in the absence of a legitimate government in Northwest Syria.Methods and materialsA governance assessment framework was adopted after an extensive literature review and group discussions. Four principles for the governance assessment framework were identified; legitimacy, accountability and transparency, effectiveness and efficiency, and strategic vision. Focus Group Discussions were held to assess the levels of the selected principles on the governance thermometer scale. Qualitative and quantitative data were analyzed using NVivo 12 and SPSS 22 software programs, respectively.ResultsThe level of the four principles on the governance thermometer scale was between the lowest and middle quintiles; ‘very poor or inactive’ and ‘fair and requires improvement’, respectively. The results indicate that the governance approach of Central Bodies in NWS is underdeveloped and summons comprehensive systematic development. The poor internal mechanisms, poor planning and coordination, and the absence of strategic vision were among the most frequent challenges to developing the approach.ConclusionHumanitarian actors and donors should pay more attention to health governance approaches and tools in protracted crises. The central bodies must improve coordination with the stakeholders and, most importantly, strategic planning. Establishing or utilizing an independent planning committee, with financial and administrative independence, is crucial to maintain and improving contextual governance mechanisms in Northwest Syria.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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Fig. 3