ReBUILD for Resilience (R4R) is a six-year Research Programme Consortium (RPC) funded by Foreign, Commonwealth & Development Office (FCDO) with multiple partners based on Sierra Leone, Lebanon, Myanmar, and Nepal. In Fragile and Shock-Prone (FASP) settings (like complex emergencies and protracted crises with concentrations of displaced and vulnerable populations; settings with more chronic risks from ecological change; areas facing active conflict; those in a post-conflict and disaster rebuilding phase; and/or facing acute shocks such as epidemics and political/economic change including radical decentralization, with attendant opportunities and risks), where many of the most poor and vulnerable populations live, R4R aims to deliver high-quality, practical, multidisciplinary, operationally relevant, and scalable health system research. R4R will contribute to strengthening resilience and building stronger systems for health across multiple levels and sectors, with focus on equity, gender, disability, and social inclusion throughout the programme.

The overarching question will be: how to develop resilience capacities to ensure responsive, effective, inclusive, gender-equitable and sustainable health systems in FASP settings? Specific research questions will be focusing on single or multiple domains within the resilience framework and will explore how they can be supported and how they are interconnected (across the health system levels and between different sectors). Some of the areas for potential research questions are listed below:

  1. Social networks and collaboration: How can coordination between overlapping national health systems and providers be improved to enable service delivery and maintenance of community wellbeing and health?
  2. Strategic and flexible use of pathways and resources: How can service delivery change to increase uptake by particularly vulnerable groups, especially in fragile settings and at the most peripheral levels?
  3. Distributed control: What are the politics of intervention implementation in fragile settings? How do diverse actors and arising power structures influence service implementation at the district level in all partner settings?
  4. Inclusive and open governance, Human Resources for Health (HRH) and availability of resources: In a federal and decentralized system, like Nepal, where local systems are mandated to deliver basic services, what does strengthening local health systems to deliver basic health services that leave no one behind look like?
  5. Routine and emergency planning, monitoring and health systems learning: How can national and sub-national actors use evidence and/or data to inform health systems strengthening and routine and emergency service planning in decentralized contexts like Nepal?
  6. M&E of resilience: What metrics and processes are appropriate for and should be used to appraise the resilience of systems for health, including measures of preparedness, response, and recovery, and how would these be operationalized at different level of the FASP health system?
  7. Accountability: What are the most effective tools to improve monitoring and accountability (internal and external) in FASP settings? What are the decision-making processes for engaging communities in health system service planning and/or planning for stressors/shocks?
  8. Ensuring gender and equitable delivery of and access to quality health services and care: How can more inclusive and gender transformative models of care that are responsive to groups who are currently largely excluded from accessing care be built?

Research approach:

R4R will primarily use implementation research methodologies, including a range of participatory and innovative approaches, which are focused on understanding challenges and testing system strengthening interventions at the local health system level (building on national level research undertaken by ReBUILD) across all partner countries.

Planned outputs:

Through stakeholder mapping and engagement, R4R will produce a range of high-quality, primary research outputs while recognizing the unmet need for clear evidence summaries and user-friendly operational toolkits on key topics, providing menus of response options, and will be devoting resources to these synthetic products (thematically and geographically), based on user consultation to assess demand. Types of product will include new theoretical frameworks; country case studies on emergent phenomena; policy options; ‘how to’ guides for local decision-makers; evaluations of strategies; implementation guidance; client engagement tools; methodological toolkits (e.g. on intersectionality in FASP settings) and menus of metrics and tools suited to resilience; models for scale-up; training materials for researchers and organizations working in FASP settings; curated evidence banks; and cross-country analysis and reflection.

Completed projects:

As part of the RPC, HERD International is implementing two rapid research projects on COVID-19 briefly described below:

  1. Understanding health system resilience to respond to COVID-19 in federalized context – a case study of health workforce management at the sub-national level in Nepal: The overall aim of this study was to examine health sector policy, preparedness, and responses to COVID-19 in the federal context of Nepal, focusing on policies provisions and implementation approaches for health workforce management at the sub-national level. By doing this, we explored Nepal’s health system resilience and lessons in COVID-19 response. The study focused on understanding the health workforce management system in federalized context, as a tracer for the wider health system, at the local level for COVID-19 response and delivery of non-COVID routine health services.
  2. The gendered experience of close to community providers in Fragile and Shock Prone settings:  implications for policy and practice during and post COVID-19: The overall aim of this study was to explore the roles of Close to Community (CTC) providers and their gendered experiences during the COVID-19 pandemic in FASP Settings.
Technical LeadImplementing partnersOther technical partners
Liverpool School of Tropical Medicine (LSTM) in Liverpool
Queen Margaret University (QMU) in Edinburgh
American University of Beirut (AUB) in Lebanon
Burnet Institute and Department of Medical Research (DMR) in Myanmar
College of Medicine and Allied Health Sciences (COMAHS) in Sierra Leone
HERD International (HERDi) in Nepal
International Rescue Committee (IRC)
Oxford Policy Management (OPM)

For more information on RPC/R4R, please visit the main website from here:

Poster on health sector policy responses and health workforce management during COVID-19 in Nepal

Project Information

Thematic areas

Health system


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