285 Strengthening health system financing in complex humanitarian contexts: analysis from Northwest Syria and its implications for other disrupted contexts

Abstract PTH 8: Miscellaneous 1, B304 (FCSH), September 5, 2025, 11:30 - 12:30 Aims In Northwest Syria, successive periods of protracted war and forced displacement have led to shifting, fragile, and donor-dependent health systems. Our study aims to contribute to actionable evidence on the optimal use of scarce financial resources to reduce fragmentation, increase resilience, and build sustainability in the context of Northwest Syria and similar areas which lack strong governance and/or state presence. Methods The study took a mixed methods case study approach, using data from (1) a desk review of key reports, agency publications, and relevant databases, (2) key informant interviews and (3) an expert meeting, including drawing on the expertise of the research group. These were analysed thematically and used to develop causal loop diagrams that capture the complexities of financing in this setting. Findings were then compared with international health financing guidance to probe how fit this guidance is for disputed areas and protracted emergency settings. Results We present a diagnostic of financing arrangements in Northwest Syria, using the framework of the WHO Health Financing Progress Matrix (HFPM), highlighting specific financing bottlenecks, especially around coordination across the multiple actors, and propose interventions to support sustainable health financing and system recovery. We also propose areas of adaptation of the framework to make it more suitable to these disrupted settings. Conclusions We highlight health financing challenges but also opportunities for system strengthening in northwest Syria. While specific, these challenges reflect features that are commonly found in other disrupted settings, so better understanding of their nature and how to address them is important for moving ahead with UHC globally. Suggested adaptations of the HFPM for complex emergency and disputed settings is also a contribution to the development of this important normative and measurement tool.