Background Ongoing conflict and systematic targeting of health facilities and personnel by the Syrian regime in opposition-controlled areas have contributed to health system and governance mechanisms collapse. Health directorates (HDs) were established in opposition-held areas in 2014 by the interim (opposition) Ministry of Health (MoH), to meet emerging needs. As the local health authorities responsible for health system governance in opposition-controlled areas in Syria, they face many challenges. This study explores ongoing health system governance efforts in 5 opposition-controlled areas in Syria.
Methods A qualitative study design was selected, using in-depth key informant interviews with 20 participants purposely sampled from HDs, non-governmental organisations (NGOs), donors, and service-users. Data were analysed thematically.
Results Health system governance elements (ie, strategic vision, participation, transparency, responsiveness, equity, effectiveness, accountability, information) were considered important, but not interpreted or addressed equally in opposition-controlled areas. Participants identified HDs as primarily responsible for health system governance in opposition-controlled areas. Main health system governance challenges identified were security (eg, targeting of health facilities and personnel), funding, and capacity. Suggested solutions included supporting HDs, addressing health-worker loss, and improving coordination.
Conclusion Rebuilding health system governance in opposition-controlled areas in Syria is already progressing, despite ongoing conflict. Local health authorities need support to overcome identified challenges and build sustainable health system governance mechanisms.
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Douedari, Y., & Howard, N. (2019). Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study. International Journal of Health Policy and Management, 8(4), 233-244. doi: 10.15171/ijhpm.2018.132
MLA
Yazan Douedari; Natasha Howard. "Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study", International Journal of Health Policy and Management, 8, 4, 2019, 233-244. doi: 10.15171/ijhpm.2018.132
HARVARD
Douedari, Y., Howard, N. (2019). 'Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study', International Journal of Health Policy and Management, 8(4), pp. 233-244. doi: 10.15171/ijhpm.2018.132
VANCOUVER
Douedari, Y., Howard, N. Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study. International Journal of Health Policy and Management, 2019; 8(4): 233-244. doi: 10.15171/ijhpm.2018.132