Rebuilding Foundations: A Comparative Analysis of Primary Health Care System Resilience in Post-Conflict Tigray and Cabo Delgado

This original research article investigates the resilience of primary health care (PHC) systems in two distinct post-conflict African contexts: Tigray, Ethiopia, following the 2020–2022 war, and Cabo Delgado, Mozambique, after protracted insurgency. It addresses a critical gap in understanding how PHC systems recover and adapt following large-scale violent conflict within sub-Saharan Africa. Employing a rigorous comparative case study methodology, the analysis synthesises secondary data from health cluster reports and humanitarian response plans (2021–2024) with primary data from 35 semi-structured key informant interviews conducted with health officials, NGO staff, and community health workers in both regions during 2025. Findings reveal divergent recovery trajectories shaped decisively by pre-existing system capacities and the nature of external support. In Tigray, a historically robust PHC network experienced systemic collapse, resulting in an aid-dependent recovery constrained by profound workforce displacement and supply chain fragmentation. Conversely, in Cabo Delgado, a weaker pre-conflict system demonstrated greater adaptive resilience through community-based mechanisms and integrated humanitarian-development approaches, though marked geographic inequities persisted. The study concludes that PHC resilience is not inherent but constructed through context-specific strategies which prioritise local health workforce retention, integrated service delivery models, and adaptive, sustained community engagement. These insights are vital for policymakers and partners designing post-conflict recovery frameworks that transition from short-term humanitarian relief towards sustainable and equitable PHC.