Executive Summary
Fragile and conflict-affected settings face some of the most severe health challenges globally, including weak health infrastructure, shortages of trained health workers, disrupted supply chains, and limited access to essential services. Populations living in these contexts experience disproportionately high levels of preventable morbidity and mortality, particularly among women, children, elderly persons, and displaced populations. Strengthening Primary Healthcare (PHC) systems is widely recognized as the most effective and equitable approach to improving health outcomes and resilience in fragile settings.
This proposal presents a comprehensive program to strengthen primary healthcare systems in fragile and conflict-affected contexts across selected regions in Africa, the Middle East, and South Asia. The project focuses on restoring and improving essential health services, building local capacity, strengthening governance and health information systems, and enhancing community trust and engagement. Implemented over four years, the initiative aims to improve access to quality, people-centered primary healthcare for over one million vulnerable individuals while contributing to long-term health system resilience.
Background and Problem Statement
Fragile settings are characterized by political instability, conflict, weak institutions, and limited state capacity. Health systems in these contexts are often underfunded, fragmented, and highly dependent on humanitarian assistance. Primary healthcare facilities may be damaged or non-functional, health workers undertrained or unpaid, and essential medicines frequently unavailable.
As a result, communities face barriers to accessing basic services such as maternal and child health care, immunization, treatment of common illnesses, mental health support, and management of chronic diseases. Outbreaks of communicable diseases are common, while non-communicable diseases and mental health conditions remain largely unaddressed. The COVID-19 pandemic further exposed the vulnerability of fragile health systems and underscored the importance of strong PHC as the foundation for emergency preparedness and response.
Project Goal and Objectives
Overall Goal
To strengthen equitable, resilient, and people-centered primary healthcare systems in fragile and conflict-affected settings.
Specific Objectives
- Improve access to essential primary healthcare services for vulnerable populations.
- Strengthen the capacity, motivation, and retention of frontline health workers.
- Enhance availability of essential medicines, equipment, and supplies at PHC level.
- Strengthen health governance, coordination, and health information systems.
- Increase community trust, engagement, and accountability in primary healthcare delivery.
Target Areas and Beneficiaries
Geographic Focus
The program will be implemented in selected fragile and conflict-affected countries and regions, prioritizing areas with high unmet health needs, displaced populations, and limited service coverage.
Target Beneficiaries
- Women, children, and adolescents
- Elderly populations and persons with disabilities
- Internally displaced persons and host communities
- Frontline health workers and community health volunteers
The project is expected to directly benefit more than one million people over the implementation period.
Project Components and Key Activities
- Component 1: Restoration and Strengthening of PHC Service Delivery
- Rehabilitation and equipping of primary healthcare facilities
- Support for outreach and mobile health services in hard-to-reach areas
- Strengthening maternal, newborn, and child health services
- Integration of mental health and psychosocial support into PHC
- Component 2: Health Workforce Development and Support
- Training and mentoring of nurses, midwives, and community health workers
- Incentive and retention mechanisms for frontline health staff
- Supportive supervision and performance monitoring
- Promotion of gender-sensitive and conflict-sensitive health workforce policies
- Component 3: Essential Medicines and Supply Chain Strengthening
- Improving forecasting, procurement, and distribution of essential medicines
- Strengthening cold chain and logistics management systems
- Support for rational use of medicines and infection prevention
- Emergency preparedness and buffer stock mechanisms
- Component 4: Health Governance and Information Systems
- Strengthening district-level health planning and coordination
- Support for health management information systems and data use
- Strengthening referral systems between PHC and higher-level facilities
- Policy dialogue to align humanitarian and development health efforts
- Component 5: Community Engagement and Accountability
- Strengthening community health committees and feedback mechanisms
- Health promotion and disease prevention campaigns
- Engagement of local leaders, women’s groups, and youth networks
- Community-based monitoring of service quality and access
Gender, Equity, and Conflict Sensitivity
The project adopts a strong equity and conflict-sensitive approach, ensuring that services reach marginalized and conflict-affected populations without exacerbating tensions. Gender-responsive programming will address barriers faced by women and girls in accessing healthcare, including cultural norms, safety concerns, and affordability. Special attention will be given to survivors of gender-based violence and persons with disabilities.
Health Security and Resilience
Strengthened primary healthcare systems will enhance early disease detection, outbreak response, and emergency preparedness. Integration of surveillance, community reporting, and referral systems will contribute to national and global health security. The project will promote flexible, shock-responsive PHC models adaptable to evolving crises.
Implementation Strategy and Partnerships
The program will be implemented through partnerships with ministries of health, local authorities, international and national NGOs, UN agencies, and community-based organizations. Strong coordination mechanisms will align humanitarian and development actors, ensuring continuity of care and sustainability. Capacity transfer to local institutions will be prioritized.
Monitoring, Evaluation, and Learning
A robust Monitoring, Evaluation, and Learning (MEL) framework will track progress, outcomes, and impact. Key indicators include:
- Coverage of essential PHC services
- Health worker availability and retention rates
- Availability of essential medicines at PHC facilities
- Community satisfaction and trust levels
Baseline, midline, and endline assessments will inform adaptive management and learning.
Expected Outcomes and Impact
- Improved access to quality primary healthcare services
- Reduced preventable morbidity and mortality
- Strengthened health workforce capacity and motivation
- Enhanced resilience and preparedness of health systems
- Increased community trust and engagement in healthcare services
Budget Overview
The indicative budget will cover facility rehabilitation, workforce support, medicines and supplies, community engagement, monitoring, and program management. Blended financing from donors, humanitarian funds, and government contributions will be pursued. A detailed budget will be developed during the inception phase.
Sustainability and Exit Strategy
Sustainability will be achieved through capacity building of local health institutions, integration with national health strategies, and gradual transition to domestic financing where feasible. The exit strategy emphasizes institutional ownership, strengthened governance, and long-term resilience of PHC systems.
Conclusion
Strengthening primary healthcare systems is essential for improving health outcomes and resilience in fragile settings. This proposal offers an integrated, people-centered, and conflict-sensitive approach that bridges humanitarian and development efforts. By investing in primary healthcare, the project will save lives, restore dignity, and contribute to sustainable peace and development
