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Framework for the evaluation of military health systems
  1. Ryan Leone1,
  2. J Whitaker2,
  3. Z Homan3,
  4. L Bandekow4 and
  5. M Bricknell1
  1. 1Conflict and Health Research Group, King's College London—Strand Campus, London, UK
  2. 2Department of Vascular Surgery, Royal Free Hospital NHS Trust, London, UK
  3. 3War Studies, King's College London—Strand Campus, London, UK
  4. 4Worldwide Military-Medicine Almanac, Bonn, Germany
  1. Correspondence to Professor M Bricknell, Conflict and Health Research Group, King's College London—Strand Campus, London, UK; martin.bricknell{at}


The organisation of a military health system (MHS) differs from the civilian system due to the role of the armed forces, the unique nature of the supported population and their occupational health requirements. A previously published review of the Military Medical Corps Worldwide Almanac demonstrated the value of a standardised framework for evaluation and comparison of MHSs. This paper proposes such a framework which highlights the unique features of MHSs not covered by health services research of national health systems. These include: national context and summary; organisational structure; firm base facilities, healthcare beneficiaries and medical research; operational capabilities, overseas deployments, collaborations and alliances; personnel including recruitment, training and education; and history and culture. This common framework can help facilitate international collaboration between military medical services including capability development, training exercises and mutual support during military operations. It can also inform national contributions to future editions of the Almanac.

  • organisation of health services
  • International health services
  • public health
  • medical education & training

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  • Twitter @MartinBricknell

  • Contributors MB conceived the paper. RL conducted the primary research. ZH analysed case-studies. JW provided extensive revisions. LB provided source-specific insights, and all authors reviewed the drafts. MB is the guarantor for the paper.

  • Funding This study was funded by UK Research and Innovation GCRF Research for Health in Conflict (R4HC-MENA ES/P010962/1).

  • Competing interests MB retired from the appointment of UK Surgeon General in April 2019. JW is a serving member of the UK Defence Medical Services. LB is the Editor-in-Chief of the Worldwide Military Medical Almanac.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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