Examining Fragility of Health Systems in Afghanistan: Development and Application of a Theoretical Framework for Fragile Health Systems
Abstract
Globally, health systems face destabilization amidst conflicts and natural disasters, adversely affecting populations' well-being. Understanding domains of health system fragility remains a gap in literature, hampering effective mitigation. In protracted conflict, Afghanistan's health system offers a crucial case for studying health system fragility. This research aimed to bridge gaps in comprehending health system fragility, with research questions:
1. What is the conceptual understanding of the fragility of health systems and its relationship with resilience, and how can it be applied in Afghanistan?
2. Did the introduction of female health workers to support Maternal, Neonatal, and Child Health service delivery by Afghan Red Crescent Society's Mobile Health Teams lead to a change in service delivery outcomes?
Methods
Grounded Delphi Methodology was used to conceptualize health system fragility in Afghanistan. Quantitative approach used Interrupted Time Series analysis, validating findings through qualitative content analysis.
Key Findings
Fragility of health systems is driven by several factors, outlined through a seven-domain framework. Afghanistan's health system is primarily fragile due to its reactive and uncertain nature. Mitigating factors contributing to these fragility domains reduce fragility, as evidenced by the improved delivery of postnatal care services by Afghanistan Red Crescent Mobile Health Team following introduction of midwives, particularly in most insecure provinces.
Conclusion
Health system fragility is complex, context-dependent, intricately related to resilience of systems. Context-driven interventions show promise in improving health system fragility. Further exploration of the conceptual framework on fragility through real-world cases can enhance our understanding of health system fragility factors and mitigation efforts.