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

Abstract

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.