ReBUILD for Resilience (R4R) is a six-year Research Programme Consortium (RPC) funded by Foreign, Commonwealth & Development Office (FCDO) with multiple partners based on Sierra Leone, Lebanon, Myanmar, and Nepal. In Fragile and Shock-Prone (FASP) settings (like complex emergencies and protracted crises with concentrations of displaced and vulnerable populations; settings with more chronic risks from ecological change; areas facing active conflict; those in a post-conflict and disaster rebuilding phase; and/or facing acute shocks such as epidemics and political/economic change including radical decentralization, with attendant opportunities and risks), where many of the most poor and vulnerable populations live, R4R aims to deliver high-quality, practical, multidisciplinary, operationally relevant, and scalable health system research. R4R will contribute to strengthening resilience and building stronger systems for health across multiple levels and sectors, with focus on equity, gender, disability, and social inclusion throughout the programme.
The overarching question will be: how to develop resilience capacities to ensure responsive, effective, inclusive, gender-equitable and sustainable health systems in FASP settings? Specific research questions will be focusing on single or multiple domains within the resilience framework and will explore how they can be supported and how they are interconnected (across the health system levels and between different sectors). Some of the areas for potential research questions are listed below:
- Social networks and collaboration: How can coordination between overlapping national health systems and providers be improved to enable service delivery and maintenance of community wellbeing and health?
- Strategic and flexible use of pathways and resources: How can service delivery change to increase uptake by particularly vulnerable groups, especially in fragile settings and at the most peripheral levels?
- Distributed control: What are the politics of intervention implementation in fragile settings? How do diverse actors and arising power structures influence service implementation at the district level in all partner settings?
- Inclusive and open governance, Human Resources for Health (HRH) and availability of resources: In a federal and decentralized system, like Nepal, where local systems are mandated to deliver basic services, what does strengthening local health systems to deliver basic health services that leave no one behind look like?
- Routine and emergency planning, monitoring and health systems learning: How can national and sub-national actors use evidence and/or data to inform health systems strengthening and routine and emergency service planning in decentralized contexts like Nepal?
- M&E of resilience: What metrics and processes are appropriate for and should be used to appraise the resilience of systems for health, including measures of preparedness, response, and recovery, and how would these be operationalized at different level of the FASP health system?
- Accountability: What are the most effective tools to improve monitoring and accountability (internal and external) in FASP settings? What are the decision-making processes for engaging communities in health system service planning and/or planning for stressors/shocks?
- Ensuring gender and equitable delivery of and access to quality health services and care: How can more inclusive and gender transformative models of care that are responsive to groups who are currently largely excluded from accessing care be built?
R4R will primarily use implementation research methodologies, including a range of participatory and innovative approaches, which are focused on understanding challenges and testing system strengthening interventions at the local health system level (building on national level research undertaken by ReBUILD) across all partner countries.
Through stakeholder mapping and engagement, R4R will produce a range of high-quality, primary research outputs while recognizing the unmet need for clear evidence summaries and user-friendly operational toolkits on key topics, providing menus of response options, and will be devoting resources to these synthetic products (thematically and geographically), based on user consultation to assess demand. Types of product will include: new theoretical frameworks; country case studies on emergent phenomena; policy options; ‘how to’ guides for local decision makers; evaluations of strategies; implementation guidance; client engagement tools; methodological toolkits (e.g. on intersectionality in FASP settings) and menus of metrics and tools suited to resilience; models for scale up; training materials for researchers and organizations working in FASP settings; curated evidence banks; and cross-country analysis and reflection.
As part of the RPC, HERD International is implementing two rapid research projects on COVID-19 briefly described below:
- Understanding health system resilience to respond COVID-19 in federalized context – a case study of health workforce management at sub-national level in Nepal: The overall aim of this study is to examine health sector policy, preparedness, and responses for COVID-19 in federal context of Nepal, focusing on policies provisions and implementation approaches for health workforce management at sub-national level. By doing this, we will explore Nepal’s health system resilience and lessons in COVID-19 response. The study will also focus on understanding the health workforce management system in federalized context, as a tracer for the wider health system, at the local level for COVID-19 response and delivery of non-COVID routine health services.
- The gendered experience of close to community providers in Fragile and Shock Prone settings: implications for policy and practice during and post COVID-19: The overall aim of this study is to explore the roles of Close to Community (CTC) providers and their gendered experiences during the COVID-19 pandemic in FASP Settings.
|Technical Lead||Implementing partners||Other technical partners|
|Liverpool School of Tropical Medicine (LSTM) in Liverpool|
Queen Margaret University (QMU) in Edinburgh
|American University of Beirut (AUB) in Lebanon|
Burnet Institute and Department of Medical Research (DMR) in Myanmar
College of Medicine and Allied Health Sciences (COMAHS) in Sierra Leone
HERD International (HERDi) in Nepal
|International Rescue Committee (IRC)|
Oxford Policy Management (OPM)
For more information on RPC/R4R, please visit the main website from here: https://rebuildconsortium.com/rebuild-for-resilience/
Associated Team Members
Shophika RegmiSenior Manager: Health System Research, Evaluation and Learning
Personal bio Ms Shophika has been working in health and social research for nearly a decade. During these years, she has led and managed research projects of different nature and scale, which include implementation research, evaluation research, national level surveillance study, large-scale survey and mixed methods studies. She also has a good experience of literature and policy reviews using systematic review and critical appraisal techniques. Having a keen interest in health systems research, her current engagements are focused on health [...]Learn more
Sushil Chandra BaralManaging Director
Key Expertise Dr Sushil Chandra Baral is an experienced heatlh and development expert of Nepal, specialising in health systems strengthening and health policy and planning at the national and international level. He has twenty five years of experience in health systems and services, health policy and planning, operational research and social development sector in developing countries context. He has got considerable professional experience in health system, health policy and planning, health service delivery, health research and programme management. He has [...]Learn more
Abriti ArjyalResearch Manager: Qualitative and Multidisciplinary Science
Key Expertise Ms. Abriti Arjyal works as Research Manager – Multidisciplinary Qualitative Research – at HERD International and has experience in the area of public health, health system and service delivery research, social science and gender, and equity. She is an emerging young researcher with more than seven years of experience leading formative and operational field studies, evaluation studies, and literature reviews, with expertise in design and implementation of qualitative research, and various community and participatory based approaches. She has sound knowledge [...]Learn more