Title: Health Systems in Fragile Settings (HSF)
Keywords: Universal health coverage
International/Global Health
Health systems
Health Policy
Conflict affected setting
Country: United Kingdom
Institution: UK - Institute for Global Health and Development, Queen Margaret University, Edinburgh
Course coordinator: Maria Bertone
Date start: 2024-02-26
Date end: 2024-03-29
About duration and dates: 5 weeks
Classification: advanced optional
Mode of delivery: Distance-based
Course location:
Delivered electronically from IGHD, Edinburgh
Institute for Global Health and Development,
Queen Margaret University,
Edinburgh, EH21 6UU Scotland
Tel. 44 131 474 0000
Fax. 44 131 474 0001

tropEd representative: Dr. Paul Kadetz
ECTS credit points: 5 ECTS credits
150 SIT:
● Self-directed individual study of online materials and readings: 25h per week = 25 x 4 =100 hours
● Participation on moderated discussion boards or synchronous sessions: 5h per week = 5 x 4 = 20 hours
● Assignment preparation: 30 hours
Language: English
At the end of the module, the student should be able to:
● Describe and critically evaluate strategies, policies and options for strengthening the health system in fragile settings
● Analyse the political, historical, social, cultural and economic foundations that underlie fragility and conflict with reference to a selected case study
● Explain and critique the roles of the key actors and institutions involved in responding to crisis, supporting recovery and strengthening capacity of the health system
● Assess how health system interventions and policies might (or not) contribute to stability, peace and state-building.
Assessment Procedures:
Assessment will be based on two assignments, reflecting the key components of the module and building on each other. Students will select a case study setting/country at the beginning of the module and will use this setting to apply their critical thinking during the online discussions and for the mini-assignments. Mini-assignments will consist of a short essay, describing and critically analysing:
(i) the background of the selected case study and the drivers of fragility and conflict; and challenges relating to the main health system’s building blocks and approaches/ policies/interventions to address them (60% of final mark);
(ii) the role of external actors and internal players in the strengthening of the health system; conclusions and potential recommendations for that setting (40% of final mark).

Students receive electronic feedback and comments via the virtual learning platform (Blackboard). Students must pass both components of the assessment in order to pass the module (pass mark is 50%). If a student fails an assessment they are allowed to resubmit their assignment within an agreed time period. Marks for resubmissions are capped at 50%

The two assignments build on one another and students interact with one another and the lecturer on their chosen topic, and this guarantees that it is the students’ personal work.

Assignment 1: Based on the chosen case study/setting, provide (i) a short description of the history and background to fragility and conflict in that setting, (ii) an analysis of the challenges relating to each of the health system’s building blocks and (iii) an assessment of the approaches/ policies/interventions adopted (or not) to address those challenges (1,800 words)
Assignment 2: Based on the chosen case study/setting and building on your mini-assignment 1, provide (i) a description of the role of external actors and internal players in strengthening of the health system; a final critical reflection on the health system’s challenges and achievements, including potential recommendations for that setting (1,200 words)
In countries affected by political and social fragility and conflict/crisis, health and well-being of populations and communities are at high risk. In these contexts, health systems have deteriorated, are fragmented and often inequitable. In some cases, external and/or humanitarian assistance is the main source of care. The core of this module rests in exploring the challenges to the health system’s building blocks that are specific to fragile settings and the policies and interventions that have emerged to address those challenges. Additionally, key debates over the definition of fragility and resilience, as well as the political, historical, social, cultural and economic foundations that underlie fragility and conflict are discussed. Issues and questions around legitimacy, coherence and capacity of governmental authorities, as well as the roles of other actors such as non-state providers and external organisations will be discussed and analysed.

Learning Units:

● What is fragility? How does fragility affect the health system?
● What are the nature and causes of conflict and ‘fragility’?
● Conceptualization of fragility and resilience: implications for health systems strengthening

Health system approaches and interventions
● Health financing approaches
● Health workforce interventions
● Service delivery and Essential Packages of Health Services
● Community responses, accountability, trust and health systems

Current debates on HSS interventions and research
● Health system interventions, governance and peace/state-building
● Role of the non-state sector in health service provision
● Current issues and trends in the global response system: humanitarian-development nexus
● Doing research in fragile, conflict-affected settings: issues and challenges for researchers, participants and communities
Each Learning Unit comprises approximately 8-9 hours of guided study material, which includes activities ranging from specified readings, narrated PowerPoints, videos and podcasts, each accompanied by prompting questions. This varies from general reflection on the content of the unit; through specified reflection exercises on specific topics; to guided sharing of analyses with other participants for peer review and feedback. Based on these questions, students will spend about 1 hour per learning unit/3 hours per week posting materials on the Discussion Board (which is accessible to tutors and participants) and reviewing/ commenting on other students’ posts. Additionally, each week participants will attend a synchronous session, which will last approximately 2 hours. The content of these sessions will vary each week, but it will normally require active participation from students – e.g., in the form of an interactive lecture (with questions or group discussion throughout) or in the form of a seminar. Time for Q&A including on practical aspects of the course will be always allowed.

Students will be encouraged to draw on their personal and professional experience, where relevant, throughout the module and contribute actively to the online discussions.
● English level TOEFL 550 or IELTS 6.0 or equivalent for applicants for whom English is not their first language
● Regular access to a computer and the internet (broadband) for the duration of the module.
● Basic computer skills, including using the world-wide web
Maximum number of students is 30 (no limit on number of TropEd students)
No specific selection criteria apply – first come first served principle. Applications stay open until two weeks before the course starts.
SCOT/UK/International £750
Not available
Major changes since initial accreditation: This is an updated version of the modules Rebuilding Health Systems – Analysing the challenges in fragile and disrupted states (offered online until AY 18-19) and Strengthening Health and Health Systems in Fragile and Conflict-affected States (offered face-to-face in AY 19-20).

The course coordinator has changed due to retirement (this change was already effective in AY 19-20). Objectives and content have been updated to give more prominence to the challenges concerning the health systems building blocks in fragile settings and the policy options to address them. New content has been added on the current debates around the “humanitarian-development nexus” as well as on “doing research in fragile, conflict-affected settings”. These changes were made with the objective of focusing the module on practical issues and approaches to health systems strengthening in fragile settings, including from an implementation perspective.
In line with this, assessment has been modified to reflect the focus on the analysis of a specific case study and the specific challenges/options in relation to the health system building blocks. The assignment has also been divided in two mini-assignments, following students’ feedback (see below).
Student evaluation: The module has been in general very well received. In the last two year’s evaluations, it was considered that learning objectives were achieved (100% either agreed or strongly agreed), classes were well prepared and organised (100% either agreed or strongly agreed), the pace of the module was right (‘about right’ = 89% in AY 18-19, 100% in AY 19-20), the coursework at the right level (100%), and the module overall interesting (100% marked interesting or very interesting) and relevant ((100% marked relevant or very relevant).
Specific positive comments were made on content, resources and lecturers.

One issue raised concerned the assignment as students expressed a preference to avoid a single summative assignment. (“I think it would have been nice to have had one or two smaller assignments throughout the course”). This comment was taken up in the present review of the module and a further assignment has been added.
Lessons learned: The pressure of only having one summative assignment for modules such as this can be substantial and we have therefore decided to substitute this with 2 assignments that build on one another.
tropEd accreditation:
Accredited in Antwerp (EC TelCo) November 2017. Reaccredited at Online GA (Hamburg) June 2020. This accreditation is valid until June 2025.
Main textbooks:
Howard, N., Sondorp, E., ter Veen, A. (editors). 2012. Conflict and health. Berkshire: Open University Press.
WHO. 2009. Analysing Disrupted Health Sectors; a modular manual. Geneva: World Health Organization
Email Address: PKadetz@qmu.ac.uk
Date Of Record Creation: 2017-11-26 04:40:01 (W3C-DTF)
Date Of Record Release: 2017-11-26 09:54:28 (W3C-DTF)
Date Record Checked: 2018-06-21 (W3C-DTF)
Date Last Modified: 2024-01-02 11:38:54 (W3C-DTF)