When the system fails, the community leads: field insights from the self-efficacy and knowledge (SEEK) trial during Lebanon's 2024 active conflict.

Abstract

Background: Adolescent girls and young women affected by conflict experience persistent sexual and reproductive health challenges along with poorer mental health and wellbeing. Among Syrian adolescent girls and young women living in Lebanon, these challenges are exacerbated by displacement, economic challenges, and barriers to accessing needed health services. Community-based interventions are being increasingly adopted to address these gaps, however evidence remains limited on how these interventions can be effectively implemented while preserving fidelity and quality during periods of active conflict, especially when centralized delivery models are not feasible.

Main body: This paper presents a comment on implementation insights from the Self-Efficacy and Knowledge (SEEK) trial, a community-based integrated intervention conducted in two primary healthcare centers in Lebanon to improve sexual and reproductive health service uptake and psychosocial wellbeing among Syrian adolescent girls and young women aged 15-24. Specifically, during implementation, escalating conflict severely restricted mobility and on-site supervision by the central team, threatening intervention continuity. As a result, the team shifted the implementation model from a centralized structure to a decentralized one, emphasizing co-leadership with local communities. To that end, local and affected community members were recruited, trained, and supervised to assume responsibility for field coordination, management of logistical procedures, and decision-making in real time, supported by remote supervision. Subsequent outcome evaluations identified positive effects on some outcomes, and limited effects on others, indicating that SEEK's effectiveness varied across outcomes. Beyond these findings, the experience highlighted how adaptive approaches that shift power to affected communities during implementation amid active conflict can transform contextual constraints into opportunities for culturally responsive and resilient implementation.

Conclusion: The implementation of SEEK demonstrates that community-led models may not be merely emergency substitutes when traditional delivery systems fail, but foundational strategies for effective humanitarian programming during conflict. Shifting power to local and affected communities as co-implementers can strengthen ownership, adaptability, and sustainability during active conflict. Community leadership, supported by flexible planning and agile decision-making may be essential for building resilient health interventions.