Weaving Security Blankets: Maximizing Local Organizations’ Impact on Health in Fragile Settings

For the twelfth consecutive year, the number of people forcibly displaced globally has increased. It is currently at an all-time record. As levels of fragility, conflict, and violence increase across the globe, healthcare is becoming harder to access, especially for women and girls who need access to family planning and maternal, newborn, and child health (MNCH) services. In fragile and conflict affected settings, healthcare delivery is especially reliant on local actors who know their communities best and can mitigate the health impacts of violence and uncertainty. Chemonics is partnering with these crucial local organizations in several ways. First, we are creating opportunities to learn from these organizations and align our support with their needs. This ensures they can adequately, sustainably, and reliably meet the MNCH and family planning needs of conflict affected communities. Second, we are working with local organizations to strengthen their ability to apply innovative systems thinking strategies to maximize the impact of their knowledge, skills, and expertise.

Learning from Local Organizations to Align Support

While Chemonics regularly learns from our local partners through the CLA process, feedback loops, and pause and reflect sessions, we wanted to create additional space to learn from local organizations. Last year, we hosted a global collaboration event – Meeting the Moment: Local Changemakers Lead in Fragile and Conflict Settings – which brought together 40 partners from 20 different countries to share their experience promoting conflict-aware development and peacebuilding, with a focus on actionable feedback for donors and implementing partners. Partners working in the health sector discussed the use of systems thinking and how it maximized impact to strengthen health systems and improve outcomes. Systems thinking is an approach to problem solving that recognizes problems as part of a wider, dynamic system and requires engaging diverse stakeholders, collectively understanding system complexities, designing and implementing systems changes, and monitoring the effects to inform continuous improvement. This approach not only addresses immediate health challenges but also strengthens the overall health system, promoting long-term stability and health outcomes. By fostering local ownership and capacity-building through systems thinking, development organizations can ensure that health interventions are sustainable, scalable, and capable of evolving with the needs of the community.

Strengthening Use of Systems Thinking to Increase Impact

Building on the conversations around systems thinking that took place at the Meeting the Moment event, Chemonics is continuing to explore how to strengthen and institutionalize use of systems thinking, especially in fragile and conflict affected settings. On USAID’s global private sector engagement project, Frontier Health Markets (FHM) Engage, Chemonics and its partners are using systems thinking to improve access to family planning commodities. In Sierra Leone, a World Bank-classified fragile context, FHM Engage used an innovative tool to help visualize youth need and demand for family planning products. Using the data generated, FHM Engage brought together policy makers, advocates, youth representatives, and local organizations to co-design ways to increase adolescents’ access to contraceptives. This public-private partner dialogue resulted in a roadmap of actionable next steps which has – so far – resulted in the establishment of a national level private sector engagement unit and the formation of two thematic working groups.

The Ethiopian Midwives Association (EMwA), the leading association in Ethiopia, draws upon their 22 years of experience supporting midwives working in conflict settings to offer a roadmap of what effective collaboration looks like. Through generous financial and technical support from the United Nations Population Fund and the Ethiopian Ministry of Health, EMwA deployed more than 500 midwives to conflict areas within Ethiopia during the recent civil war to provide comprehensive maternal, child, and reproductive health services for vulnerable women and girls. EMwA is also leading a humanitarian research project aimed at evaluating midwife-led reproductive care in northern Ethiopia. They are embodying systems thinking by engaging many different stakeholders, from patients and healthcare workers to district managers and policy makers, to collectively understand and address the barriers to quality healthcare.

Since conflict is unpredictable, relational networks are even more important to being able to respond to urgent health needs effectively. However, co-creation is more than a one-time event; there is a need to continuously collaborate to make the investments more sustainable. Chemonics is building relationships with local organizations, like EMwA, to further amplify their work, ensure their findings are accessible and usable for decision makers, and incorporate their recommendations across our programming.

Solina Center for International Development and Research, an Abuja-based healthcare management and consulting firm who also participated in the Meeting the Moment event, partners with Chemonics on FHM Engage to diagnose the market-related root causes of MNCH and family planning underperformance in two Nigerian states. This information is used to co-develop solutions that strengthen the capacity of private providers to deliver quality MNCH and family planning services and improve equal access to high-quality health products, services, and information. Solina engages local and state governments to ensure the right representatives are involved in shaping program design as they serve as a key bridge between the donor (USAID) and those most familiar with the context and challenges (frontline health workers and clients). This link is especially crucial in conflict-affected states where adaptability and a deep understanding of the local context is crucial.