Systematic Review: Working with Non-State Providers in Post-Conflict & Fragile States in Primary Healthcare Service Delivery

Systematic review and protocol for the review


This review examined the evidence on strategies for how governments of post-conflict and fragile states can effectively engage non-state providers, with a view to strengthening health systems and improving health outcomes. It sought to answer 2 research questions:

  1. How effective are different approaches of engaging with non-state providers in improving the delivery of primary healthcare in fragile, conflict or post–conflict settings?

  2. What is the impact of non-state actors’ delivery of primary healthcare in fragile, conflict or post-conflict settings?

The review systematically screened 7,946 titles and abstracts before selecting 107 full texts to inform the evidence on impacts. The review found high quality and moderate evidence on the impact on health outcomes of a range of interventions and approaches, including community empowerment, community health insurance and pay for performance. Although there is a growing body of evidence on the impact of interventions measuring health outcomes delivered by non-state actors in post-conflict and fragile states, the overall quality of this evidence is low to moderate. There is a need for more high quality studies across all areas covered in this review. In addition, few studies considered death or illness as the primary outcome yet this is crucial in assessing health impact at population level. Further, data on cost-effectiveness to support health outcomes was often lacking across the board.

The protocol for this systematic review was published in October 2014


Obuku E.A., Stewart R., Mijumbi R., Ochan M., Achana F., Akena D., Nakitende A., Ssemata A., Kinengyere A., Semakula D., Ssenono R., Nsangi A., Lalitha R., Mwesiga E., Akite J., Basaza R., Newbrander W., Okello J., Sewankambo N., with Dickson K., Oliver S. (2017). Working with non-state providers in post-conflict and fragile states in primary healthcare service delivery: a systematic review. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.

Published 11 August 2017