Primary healthcare delivery models in African conflict-affected settings: a systematic review

In conflict-affected settings, access to primary healthcare for displaced populations is constrained by multiple challenges. Different models of care are therefore used to provide primary healthcare to affected communities. However, there is a paucity of evidence on how these models are selected and implemented by organisations working in conflict and displacement-affected settings. Through a systematic review this study aimed to explore the different primary healthcare delivery models used in conflict-affected settings in Africa to understand gaps in existing healthcare delivery models.

The results showed that the models of care in place in these settings include health facility-based, community-based, mobile clinics, outreach and home visits. Primary healthcare for internally displaced persons and refugees is provided by a wide range of actors including national and international organisations. A range of services is offered, most commonly nutrition, mental health and sexual/reproductive health. Some organisations offer stand-alone services, while others use an integrated service delivery model. Multiple cadres of healthcare workers provide services, frequently lay healthcare workers such as Community Health Workers.

Understanding the different modalities of primary healthcare delivery in conflict-affected settings is important to identify existing practices and gaps in service delivery. Service delivery using community health workers in conflict-affected settings is a low-cost primary care delivery strategy that may help optimise contributions of existing personnel through task shifting.