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A triple burden for health sector reform: 'Post'-conflict rehabilitation in Uganda


  • Macrae, Joanna
  • Zwi, Anthony B.
  • Gilson, Lucy


While conflict continues to threaten health development in many countries, relative peace has been secured in others. The transition from war to peace carries important political and economic opportunities for the reappraisal of social policy in general, and of health policy in particular. The health systems of countries recovering from prolonged periods of conflict often carry a double burden: the inheritance of an inappropriate and unaffordable health system developed in the pre-conflict era, and the particular, long-term effects of conflict on health and health services. This paper reports on the particular policies designed to rehabilitate the Ugandan health system, and argues that they exacerbated, rather than alleviated, the health crisis inherited in 1986. In this way they posed a third burden. By analyzing the context and process of policy formulation in the immediate post-conflict period, it explores the rationale which lay behind the adoption of these policies and identifies potential strategies for strengthening policy development in these unstable, resource-poor and health-deprived situations.

Suggested Citation

  • Macrae, Joanna & Zwi, Anthony B. & Gilson, Lucy, 1996. "A triple burden for health sector reform: 'Post'-conflict rehabilitation in Uganda," Social Science & Medicine, Elsevier, vol. 42(7), pages 1095-1108, April.
  • Handle: RePEc:eee:socmed:v:42:y:1996:i:7:p:1095-1108

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    Cited by:

    1. Shuey, Dean A. & Qosaj, Fatime Arenliu & Schouten, Erik J. & Zwi, Anthony B., 2003. "Planning for health sector reform in post-conflict situations: Kosovo 1999-2000," Health Policy, Elsevier, vol. 63(3), pages 299-310, March.
    2. Andrews, Gavin J. & Kearns, Robin A., 2005. "Everyday health histories and the making of place: the case of an English coastal town," Social Science & Medicine, Elsevier, vol. 60(12), pages 2697-2713, June.
    3. Jitta, Jessica & Whyte, Susan Reynolds & Nshakira, Nathan, 2003. "The availability of drugs: what does it mean in Ugandan primary care," Health Policy, Elsevier, vol. 65(2), pages 167-179, August.
    4. Gonzalez Block, Miguel Angel, 1997. "Comparative research and analysis methods for shared learning from health system reforms," Health Policy, Elsevier, vol. 42(3), pages 187-209, December.
    5. Jeppsson, Anders & Birungi, Harriet & Ostergren, Per-Olof & Hagstrom, Bo, 2005. "The global-local dilemma of a Ministry of Health: Experiences from Uganda," Health Policy, Elsevier, vol. 72(3), pages 311-320, June.
    6. Judith Kabajulizi, 2013. "Macroeconomic Implications Of Health Sector Reforms In Uganda: A Computable General Equilibrium Analysis," EcoMod2013 5158, EcoMod.
    7. Kruk, Margaret E. & Freedman, Lynn P. & Anglin, Grace A. & Waldman, Ronald J., 2010. "Rebuilding health systems to improve health and promote statebuilding in post-conflict countries: A theoretical framework and research agenda," Social Science & Medicine, Elsevier, vol. 70(1), pages 89-97, January.


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