Central desks as an approach for health governance in conflict settings - case studies from northwest Syria

Abstract

Background: The conflict in Syria affected severely the health sector; health infrastructure was damaged, the Damascus ministry of health withdrew from opposition held areas, health workers fled the country, and there has been always a shortage of funding and medical supplies. To address these needs, Syrian NGOs, INGOs, donors, and UN Agencies have been providing health interventions through humanitarian channels. However, many of these interventions were short termed, and there was no governance framework to guide the newly introduced parallel system, leaving it subject to individual organizations’ strategies and approaches. To counter these challenges, local communities and Syrian NGOs established new platforms to govern and coordinate certain aspects of the health sector. These platforms are called “central desks”, which are perceived to be independent and neutral structures and can coordinate services between all actors. Examples of these structures are Syrian Immunization Group (SIG), Health Information System (HIS), the Infection Protection and Control initiative (IPC), and the Referral System network. Methods: The research was based on an institutional approach to governance as presented by (Abimbola et. Al, 2017) and (Baez-Carmago and Jacobs, 2011) of health governance. We have investigated the central desks across the main themes; governance inputs of these central desks, such as strategic vision and legitimacy; governance processes, such as accountability and transparency, and governance outcomes, such as effectiveness and efficiency. Further to intensive literature review, eight focus group discussion were conducted, average pf 12 participants. Key themes then were deducted and coded. The qualitative analysis was done using NVIVO 12 software. Conclusion: Central desks, that are not part of national ministries of health, are new innovative approaches that can increase the efficiency of health interventions in conflict settings. The detailed features of such desks should be context specific and locally informed and led.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

MAA, MAK, ZA, and AE received support from the National Institute for Health Research (NIHR - grant number 131207), Research for Health Systems Strengthening in northern Syria (R4HSSS), using UK aid from the UK Government to support global health research. Website: https://fundingawards.nihr.ac.uk/award/NIHR131207 The views expressed in this publication are those of the author(s) and do not necessarily reflect those of the NIHR or the UK government. The funder was not invovled in any aspects of the desing or the implementation of this study. The funder has not reviewed the manuscript and they were not invovled in deciding on publication.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The research was part of a PhD thesis that received an ethical approval from the Institutional review baord of King's College London: (reference number is MRSP-19/20-17756) dated 18 Feb 2020. The research received a local ethical approval from Idlib Health Directorate, which represent the local health authority in northwest Syria: reference number 12307 dated 16 June 2021.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

Data cannot be shared publicly because of conflict sensitivity. The data is related to the health governance in northwest Syria, which is a contested conflict settings. Nevertheless, the anonymised analysis of the Focus Group Discussions can be found on: DOI:10.17632/9k69zkmg3z.1

https://doi.org/10.17632/9k69zkmg3z.1

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