From Ground Realities to Policy: A Framework for Assessing Multipolar Health System Governance in Conflict-Affected and High-Risk Areas
This research introduces a novel institutional framework specifically designed to assess and evaluate health system governance in conflict-affected and high-risk areas (CAHRAs). Recognizing that traditional, hierarchical governance models often fail in fragmented settings, the study develops a two-step approach—descriptive and evaluative—to capture the complexities of “multipolar” health systems. By integrating power dynamics, stakeholder roles, and eleven core principles such as legitimacy, localization, and conflict-sensitive transparency, the framework provides a practical tool for policymakers and practitioners. Drawing on extensive field experience from Northwest Syria, the paper offers a structured methodology to navigate the non-traditional leadership and coordination challenges inherent in fragile environments.
Authors and Contributors:
This study was authored by a multidisciplinary team of experts: Munzer Alkhalil and Zedoun Alzoubi, alongside Salah Safadi, Aula Abbara, Abdulkarim Ekzayez, Alvaro Alonso Garbayo, and Karl Blanchet. The work was supervised and co-authored by Paul Spiegel and Sameen Siddiqi
