Frontlines and Faultlines: Governing Health Systems in Fragile Contexts through Gendered Realities of Health Work

As global health systems confront overlapping crises—armed conflict, political instability, pandemics, and shifting geopolitical dynamics—Faultline’s in governance become more pronounced. Structural inequities embedded in policies and institutions are exposed in crises and, worse, are further reinforced, with the health workforce offering a clear example. Women health workers form the backbone of service delivery in fragile contexts, providing essential care under conditions of insecurity, violence, resource scarcity, and institutional fragility. Despite these challenges, many innovate to overcome shortages, build trust with communities, and sustain healthcare in the absence of strong institutional support. Their resilience highlights the potential of inclusive governance that values frontline realities. Yet, women health workers are often undervalued, underpaid, and excluded from decision-making, leaving them vulnerable to exploitation and burnout. Lessons from contexts where frontline workers have mobilized for change demonstrate pathways toward more resilient, equity-driven governance models. This session contributes to contemporary debates by centering gendered experiences in shaping governance responses to fragility and conflict, while adopting an intersectional approach.

This session examines how the gendered realities of frontline health work intersect with governance challenges in fragile and conflict-affected health systems. Drawing on lessons from diverse country experiences—including Ukraine, Sudan, Nigeria, the Democratic Republic of Congo (DRC), Gaza, and Myanmar—the session highlights enabling strategies, mechanisms, and contextual factors—including strong social movements—that help overcome barriers, strengthen system responses, and achieve accountability in health governance. A key objective is to identify transferable lessons that can inform governance approaches in other fragile contexts, particularly those that recognize and support the contributions of marginalized health worker groups, often women, to health system resilience.