Post-conflict states in Southern Africa face complex challenges in rebuilding their medical systems. A clear understanding of the specific obstacles and potential avenues for improvement is needed for effective policy and practice in these fragile contexts, particularly in obstetrics and gynaecology. This meta-analysis aimed to systematically synthesise existing literature to identify and analyse the predominant challenges and opportunities for medical systems, with a focus on maternal and reproductive health services, in post-conflict states within the Southern African region. A systematic search of multiple academic databases was conducted for relevant qualitative, quantitative, and mixed-methods studies. Eligible studies were critically appraised, and data were extracted using a standardised protocol. Thematic synthesis was employed for qualitative findings, while quantitative data were summarised narratively due to heterogeneity. Key challenges identified included severe human resource shortages, particularly in specialist care, and fragmented health infrastructure. A prominent theme was the widespread disruption of routine antenatal and postnatal care services. Opportunities centred on leveraging non-governmental organisation partnerships and integrating community health worker programmes, which were associated with improved service uptake in several settings. Medical systems in post-conflict Southern African states are characterised by profound systemic weaknesses but also demonstrate a capacity for innovation. Strategic investment in health workforce development and integrated service delivery models is paramount for recovery. Policymakers should prioritise the training and retention of healthcare workers, especially midwives and obstetricians. Strengthening community-based care and fostering sustainable partnerships between government and aid agencies are essential for rebuilding robust medical systems. post-conflict, health systems, maternal health, Southern Africa, healthcare delivery, reconstruction, reproductive health This synthesis provides a consolidated evidence base to inform targeted interventions and research priorities for strengthening medical systems, with particular relevance to obstetrics and gynaecology, in post-conflict Southern Africa.
Mbatha et al. (Sat,) studied this question.