Karl Blanchet

University of Geneva | UNIGE · Faculty of Medicine

The main challenges in international health are to scale up effective health interventions in low- and middle-income countries in order to reach a higher proportion of the population. This can be achieved through better insight into how health systems are structured. Social network analysis can provide an appropriate and innovative paradigm for the...

In addition to those interventions proposed by Tomori,1 support is needs to fully implement the International Health Regulations (IHR),2 which provide a legally binding framework for coordinating public health emergencies of potential international concern, such as the outbreak of Ebola virus disease. Importantly, neighbouring countries need suppor...

Background Health systems strengthening is becoming a key component of development agendas for low-income countries worldwide. Systems thinking emphasizes the role of diverse stakeholders in designing solutions to system problems, including sustainability. The objective of this paper is to compare the definition and use of sustainability indicators...

Non-communicable diseases (NCDs) are of increasing concern in low- and middle-income countries (LMICs) affected humanitarian crises. Humanitarian agencies and governments are increasingly challenged with how to effectively tackle NCDs. Reviewing the evidence of interventions for NCDs in humanitarian crises can help guide future policies and researc...

Introduction Since 2000, the number and role of global health initiatives has been growing, with these platforms playing an increasingly important role in pooling and disbursing funds dedicated to specific global health priorities. While recognising their important contribution, there has also been a growth in concerns about distortions and ineffic...

Introduction Since 2000, the number and role of global health initiatives has been growing, with these platforms playing an increasingly important role in pooling and disbursing funds dedicated to specific global health priorities. While recognising their important contribution, there has also been a growth in concerns about distortions and ineffic...

Background In Myanmar, ongoing conflict since the 2021 military coup d’etat has been characterized by targeted violence against health workers (HWs), particularly those participating in the pro-democracy movement. Existing knowledge about the challenges faced by health workers in Myanmar is scant, including their perspectives on mitigating their su...

Shocks effects are under-theorised in the growing literature on health system resilience. Existing work has focused on the effects of single shocks on discrete elements within the health system, typically at national level. Using qualitative system dynamics, we explored how effects of multiple shocks interacted across system levels and combined wit...

Background In Myanmar, ongoing conflict since the 2021 military coup d’etat has been characterized by targeted violence against health workers (HWs), particularly those participating in the pro-democracy movement. Existing knowledge about the challenges faced by health workers in Myanmar is scant, including their perspectives on mitigating their su...

The 2030 Sustainable Development Goals (SDG) agenda has committed to ‘ensuring that no one is left behind’. Applying the right to health of non-citizens and international migrants is challenging in today's highly polarized political discourse on migration governance and integration. We explore the role of a priority setting approach to help support...

In November 2023, a variety of disparate health organizations formed an international coalition to consolidate efforts and develop collaborative strategies in response to the increasing critical healthcare challenges caused by the recent war in Gaza. The coalition includes medical and public health experts, humanitarian practitioners, academics, an...

The advancement of migrant-sensitive health care in Europe has been a topic of many initiatives and academics debates for over 20 years in Europe, yet with rather limited progress in terms of comprehensive and sustainable implementation. We argue that a human rights-based approach with clearly defined duties and responsibilities of governments, rel...

The number of people on the move internationally is increasing, and a sizable number of these individuals are migrating through and to the WHO European Region. The UN Sustainable Development Goals demand that we leave no one behind and ensure equitable implementation of Universal Health Coverage (UHC), regardless of immigration status. In the WHO E...

Objective Migrants and refugees are at a disadvantage in accessing basic necessities. The objective of this study is to assess the inequity in access, needs and determinants of COVID-19 vaccination among refugees and migrant populations in Pakistan. Design We conducted a mixed-method study comprising a cross-sectional survey and a qualitative stud...

The Sudan 2023 Humanitarian Response Plan was revised in May, 2023, due to the escalating violence in the country. This revision increased the scale of assistance and protection activities and suspended the funding allocated for access to livelihood, access to basic services, and for the implementation of resilience solutions. We call to rethink Su...

The scale of attacks on healthcare has become more visible and its impact greater in recent armed conflicts in Ukraine, Sudan and Myanmar. In these conflicts, combatants systematically target health facilities and ambulances. We need to ensure that attacks on healthcare do not become the new norm amongst governmental troops and non-State armed grou...

Introduction Despite rapidly growing academic and policy interest in health system resilience, the empirical literature on this topic remains small and focused on macrolevel effects arising from single shocks. To better understand health system responses to multiple shocks, we conducted an in-depth case study using qualitative system dynamics. We f...

This briefing report series are targeted at policy makers and industry members in the fields of technology governance and innovation management. Our goal is to raise awareness of the importance of societal acceptance, and to shed light on how to address it based on our own research findings. Societal acceptance of the use of drones in urban areas...

This chapter describes the main concepts and common theories of health system resilience. The chapter introduces the origins of resilience as a concept, including the resilience of complex adaptive systems, and describes the major milestones and debates as resilience developed in the field of health systems. The chapter also describes the current d...

The use of drones (or Unmanned Aerial Vehicles) in urban areas has emerged rapidly in the last decade, and continues to expand at an accelerating pace. Alongside the emergent uses of high-impact technology in both public and private sectors, political debates about the potential risks and challenges have arisen, encompassing diverse perspectives an...

The ongoing armed conflict in Sudan has resulted in a deepening humanitarian crisis with significant implications for the country's health system, threatening its collapse. This article examines the destruction, disruption, and disastrous consequences inflicted upon Sudan's health system. The conflict has led to the severe compromise of healthcare...

Health systems need to continue functioning and providing essential health services, even when they experience challenges that threaten their ability to do so. Resilience describes the ability for health systems to manage change when they are shocked, so that essential functions are maintained. The capacity to change ranges from absorbing the shock...

In 2017, in the middle of the armed conflict with the Taliban, the Ministry of Public Health decided that the Afghan health system needed a well-defined priority package of health services taking into account the increasing burden of non-communicable diseases and injuries and benefiting from the latest evidence published by DCP3. This leads to a 2-...

This briefing report series are targeted at policy makers and industry members in the fields of technology governance and innovation management. Our goal is to raise awareness of the importance of societal acceptance, and to shed light on how to address it based on our own research findings. Societal acceptance of the use of drones in urban areas...

This briefing report series are targeted at policy makers and industry members in the fields of technology governance and innovation management. Our goal is to raise awareness of the importance of societal acceptance, and to shed light on how to address it based on our own research findings. Societal acceptance of the use of drones in urban areas...

This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neg...

This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neg...

Essential packages of health services (EPHS) are a critical tool for achieving universal health coverage, especially in low-income and lower middle-income countries. However, there is a lack of guidance and standards for monitoring and evaluation (M&E) of EPHS implementation. This paper is the final in a series of papers reviewing experiences using...

Neha S Singh and colleagues argue for research and investment in effective interventions to promote the wellbeing of adolescents affected by conflict and environmental disaster

Many countries around the world strive for universal health coverage, and an essential packages of health services (EPHS) is a central policy instrument for countries to achieve this. It defines the coverage of services that are made available, as well as the proportion of the costs that are covered from different financial schemes and who can rece...

This paper reviews the experience of six low-income and lower middle-income countries in setting their own essential packages of health services (EPHS), with the purpose of identifying the key requirements for the successful design and transition to implementation of the packages in the context of accelerating progress towards universal health cove...

Objective To assess decision-making quality through piloting an audit tool among decision-makers responding to the COVID-19 epidemic in Somalia. Design and setting We utilised a mixed-methods programme evaluation design comprising quantitative and qualitative methods. Decision-makers in Somalia piloted the audit tool generating a scorecard for dec...

Background: Health challenges like coronavirus disease 2019 (COVID-19) are becoming increasingly complex, transnational, and unpredictable. Studying health system responses to the COVID-19 pandemic is an opportunity to enhance our understanding of health system resilience and establish a clearer link between theoretical concepts and practical ideas...

Background: In 2014, Terre des Hommes (Tdh) together with the Ministry of Health (MoH) launched the Integrated electronic Diagnosis Approach (IeDA) intervention in two regions of Burkina Faso consisting of supplying every health centre with a digital algorithm. A realistic evaluation was conducted to understand the implementation process, the mech...

Background Childhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effectiveness of system-level interventions for improvin...

Background Recent estimates report that 2.4 billion people with health conditions globally could benefit from rehabilitation. While the benefits of rehabilitation for individuals and society have been described in the literature, many individuals, especially in low- and middle-income countries do not have access to quality rehabilitation. As the ne...

Background Research on health systems resilience has focused primarily on the theoretical development of the concept and its dimensions. There is an identified knowledge gap in the research on how to build resilience in health systems in practice and ‘what works’ in different contexts. The aim of this study is to identify practical strategies for b...

Causal loop diagrams (CLDs) are a systems thinking method that can be used to visualise and unpack complex health system behaviour. They can be employed prospectively or retrospectively to identify the mechanisms and consequences of policies or interventions designed to strengthen health systems and inform discussion with policymakers and stakehold...

Health systems worldwide face major challenges in anticipating, planning for and responding to shocks from infectious disease epidemics, armed conflict, climatic and other crises. Although the literature on health system resilience has grown substantially in recent years, major uncertainties remain concerning approaches to resilience conceptualisat...

Health systems in fragile states need to respond to shifting demographics, burden of disease and socio-economic circumstances in the revision of their health service packages. This entails making difficult decisions about what is and is not included therein, especially in resource-constrained settings offering or striving for universal health cover...

The invasion of Ukraine has unleashed a humanitarian crisis and the impact is devastating for millions displaced in Ukraine and for those fleeing the country. Receiving countries in Europe are reeling with shock and disbelief and trying at the same time to grapple with the reality of providing for a large, unplanned, unprecedented number of refugee...

Background Childhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effectiveness of system-level interventions for improvin...

Background Handwashing with soap has the potential to curb cholera transmission. This research explores how populations experienced and responded to the 2017 cholera outbreak in the Democratic Republic of the Congo and how this affected their handwashing behaviour. Methods Cholera cases were identified through local cholera treatment centre record...

The global COVID-19 pandemic is unprecedented in its scope and impact. While a great deal of research has been directed towards the response in high-income countries, relatively little is known about the way in which decision-makers in low-income and crisis-affected countries have contended with the epidemic. Through use of an a priori decision fra...

This research aimed to qualitatively explore whether the determinants of handwashing behaviour change according to the duration of displacement or the type of setting that people are displaced to. We conducted an exploratory qualitative study in three different post-conflict settings in Northern Iraq–a long-term displacement camp, a short-term disp...

Background The high and rising global burden of non-communicable diseases (NCDs) is reflected among crisis-affected populations. People living with NCDs are especially vulnerable in humanitarian crises. Limited guidance exists to support humanitarian actors in designing effective models of NCD care for crisis-affected populations in low- and middle...

Background Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare,...

Background Cash transfers, payments provided by formal or informal institutions to recipients, are increasingly used in emergencies. While increasing autonomy and being supportive of local economies, cash transfers are a cost-effective method in some settings to cover basic needs and extend benefits of limited humanitarian aid budgets. Yet, the ext...

Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previou...

This chapter presented key agendas, international standards and principles relevant for healthcare providers caring for refugee communities in different settings and contexts. It demonstrates that international agendas, national policies and clinical practices are not disconnected spheres but intersect at several levels. International standards and...

This chapter explores an approach to culture and health that involves providing quality care in line with the human rights to health and the principle of non-discrimination. Acknowledging culture in health services does not mean categorising individuals and communities according to their geographical, ethnic or religious background, but rather aims...

Background Performance-based financing (PBF) has attracted considerable attention in recent years in low and middle-income countries. Afghanistan’s Ministry of Public Health (MoPH) implemented a PBF programme between 2010 and 2015 to strengthen the utilisation of maternal and child health services in primary health facilities. This study aimed to e...

COVAX, the global initiative on COVID-19 vaccines, has set the target of achieving a COVID-19 vaccination coverage of up to 30% of the population of 135 countries in 2 years. Here, we argue that COVAX should anticipate important and unforeseen challenges with regard to sanctioned countries. For those, COVAX needs to provide a higher percentage of t...

Background For humanitarian organisations to respond effectively to complex crises, they require access to up-to-date evidence-based guidance. The COVID-19 crisis has highlighted the importance of updating global guidance to context-specific and evolving needs in humanitarian settings. Our study aimed to understand the use of evidence-based guidanc...

Studies from several countries have shown that the COVID-19 pandemic has disproportionally affected migrants. Many have numerous risk factors making them vulnerable to infection and poor clinical outcome. Policies to mitigate this effect need to take into account public health principles of inclusion, universal health coverage and the right to heal...

We seek to strengthen understanding of the health needs of internally displaced persons (IDPs) in contexts of conflict or violence. Based upon a scoping review, our paper identified limited evidence on IDPs health, but nevertheless indicates that IDPs tend to experience worse health outcomes than other conflict-affected populations across a range o...

To meet the Sustainable Development Goals target of ending poverty “in all its forms”, it is critical to monitor progress towards poverty alleviation, including amongst people with disabilities. This research used data from a population-based nested case control studies (n=667) and compares monetary and multidimensional poverty levels amongst peopl...

Despite a surge in initiatives to integrate foreign-trained physicians into local health systems and a drive to learn from localised humanitarian initiatives under the COVID-19 pandemic, we still know little about the on-the-ground strategies developed by refugee doctors to meet the needs of refugee patients. In Lebanon, displaced Syrian health pro...

Introduction Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. They are particularly important for crisis-affected populations that typically reside in settings characterised by overcrowding, inadequate access to healthcare and resource limitations. To describe the landscape...

Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to...

Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to...

The current global systemic crisis reveals how globalised societies are unprepared to face a pandemic. Beyond the dramatic loss of human life, the COVID-19 pandemic has triggered widespread disturbances in health, social, economic, environmental and governance systems in many countries across the world. Resilience describes the capacities of natura...

Payment for performance (P4P) has been employed in low and middle-income (LMIC) countries to improve quality and coverage of maternal and child health (MCH) services. However, there is a lack of consensus on how P4P affects health systems. There is a need to evaluate P4P effects on health systems using methods suitable for evaluating complex system...

Background: For humanitarian organisations to respond effectively to complex crises, they require access to up-to-date evidence-based guidance. In addition, the COVID-19 crisis has highlighted the importance of adapting and updating global guidance to context-specific and evolving needs in fragile and humanitarian settings. Our study aimed to under...