Investing in health workforce for respectful sexual reproductive health in conflict-affected settings

Abstract Background Conflict and war disrupt healthcare systems, leading to resource constraints and limited support for healthcare providers (HCPs). Crises increase mistreatment during childbirth and hinder quality sexual and reproductive healthcare (SRH) throughout the life course. Lebanon's decades-long political turmoil and conflict escalated into war in 2024. As part of the GEMSELF implementation research to improve family planning and sexuality education, this study examined barriers and enablers to SRH service delivery from the perspectives of HCPs and user care experiences at primary healthcare centers (PHCCs), to inform the design of a multi-component health workforce development intervention. Methods A qualitative design was used. We conducted 20 key informant interviews with program staff, directors, and HCPs (physicians, nurses, midwives) and 20 focus group discussions with adolescents and adults seeking SRH care across 10 PHCCs. Data were transcribed and thematically analyzed. Results During conflict, HCPs demonstrated a heightened sense of civic responsibility with midwives playing a vital role in support and trust-building. Trust, respect, and clear communication with HCPs were essential for positive care experiences, especially for sensitive SRH issues. Participants described both supportive person-centered care and negative experiences, including rushed consultations and verbal abuse. Concerns about dignity and equity were common, with Syrian refugees reporting discrimination. Inconsistencies in provider competence, financially driven care, and facility environment affected trust and care quality. Conclusions Strengthening midwives’ roles is essential for quality SRH care in conflict settings. Professional development of HCPs should prioritize promoting respectful person-centered SRH care throughout the life course, cultivating empathy and civic responsibility to strengthen the resilience of the healthcare workforce in conflict settings. Key messages • Midwives and HCPs played a critical role in maintaining SRH care during conflict, with trust and clear communication central to positive user experiences. • Interventions for respectful SRH care throughout the life course in conflict settings should prioritize cultivating empathy, resilience, and civic responsibility within the healthcare workforce.