The humanitarian-development nexus and sexual and reproductive health interventions in fragile settings: A scoping review

The concurrent need for both humanitarian and development assistance in fragile settings and protracted emergencies has been termed the humanitarian-development nexus (HDN) or the humanitarian-development-peace nexus (HDpN). We undertook a scoping review on the operationalization of the HDpN for sexual, reproductive, maternal, newborn, child, and adolescent health interventions in fragile settings. We screened 2,570 publications, of which 36 peer-reviewed and 27 grey literature publications met inclusion criteria. Very few included studies focused on peace aspects within the HDpN and child and adolescent health. Publications by humanitarian authors often classified maternal and newborn health as a component of sexual and reproductive health (SRH). Data extraction and analysis focused on three overarching themes: SRH prioritization across the HDN, the transition between minimum and comprehensive services, and health systems strengthening. This review provides concrete guidance on how to operationalize the HDN for SRH interventions in fragile settings. Expansion of SRH preparedness measures is necessary given the current trajectory of the climate emergency and other destabilizing events. The ability to flexibly transition between minimum and comprehensive services is important for maintaining service continuity in crisis-affected settings. COVID-19 proved to be a significant disruptor of SRH services, and a key inflection point in the collaboration between humanitarian and development practitioners. The use of task-shifting, decentralization, and telemedicine were approaches that may be adopted to maintain service delivery according to different contexts. Lastly, strengthening health systems was identified as essential across the HDN. With more crises extending for years, the wider literature has emphasized the necessity of health systems strengthening for reaching the Sustainable Development Goals, including in fragile settings.