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NIHR Research Unit on Health in Situations of Fragility (RUHF)


The Research Unit on Health in Situations of Fragility (RUHF) sought to identify key challenges in the delivery of quality, accessible, equitable and accountable health services in fragile settings and determine effective strategies to address these.

Of particular concern were health conditions that require continuity of care to ensure appropriate response; the unit thus focused particularly on the treatment and prevention of non-communicable diseases (NCDs) and addressing mental health and psychosocial support needs.

The work of the unit was also characterised by:

(1) a commitment to a ‘systems for health’ analysis, recognising the wide range of dynamic influences on provision of, and access to, healthcare;

(2) strong engagement with policymakers early in the research process to ensure our research was coherent with national and global policy agendas and thus conducive for research uptake;

(3) deep contextual analysis in the fragile settings in which we focused (principally Lebanon, Sierra Leone and El Salvador); and

(4) a focus on methodological and conceptual innovation supporting rigourous research and analysis in the face of the significant challenges of fragile settings.

The work was structured with respect to six major workpackages:

Understanding and navigating fragilitySeries of conceptual and integrative studies drawing generalisable principles for work in fragile settings
Mental health and psychosocial support needs and provision in Sierra LeoneStudies considering idioms of psychological distress, determinants of wellbeing, culturally contextualised assessment and intervention strategy
Addressing the increasing burden of NCDs in Sierra Leone (and related work in Nigeria)Studies considering integration of NCD diagnosis and treatment with primary care provision, training and supervision interventions and community-based health promotion
NCD needs and services for vulnerable populations in LebanonStudies assessing health-seeking behaviour, barriers to utilization and quality and equity of provision in displacement-impacted communities
Mental health and psychosocial support needs and provision for vulnerable populations in Lebanon (and related work in Gaza)Studies assessing community perceptions of mental health needs and barriers to service access in displacement-impacted communities
Capacities for addressing the growing burden of NCDs in El SalvadorStudies assessing health systems capacities with respect to increasing needs related to non-communicable disease