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Health Systems in Disrupted Environments

Health Care in Danger, 23 April 2012, London

Peter S Hill,

Associate Professor, Global Health Systems

School of Population Health

Health systems in conflict: the distortion of violenceHealth systems in conflict: the distortion of violence

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The Distortion of Violence

Violence affects systems as well as individuals

Conflict, post conflict and other disruption

Distortion from conflict, but also local or

international responses to the conflict

Health systems often already fragile

Problems are compounded, rarely new

Yet conflict provides opportunities for change

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The research

Health Systems in Severely Disrupted

Environments funded by Danida

Six country case-studies: Afghanistan,

Central African Republic, Democratic

Republic of Congo, Hati, Palestine, Somalia

Experienced Post-Conflict researchers

Field sites, interviews, documentary analysis

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Health Services

Coverage poor, but contracts further

Mal-distribution of staff exacerbates disparities

Health service gaps rapidly filled

New priorities may emerge

Sustaining public health programs difficult Sustainable services depend on staff, available

drugs, accessible supply lines, adaptability

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Health Services

What strategies might enable

public health programs to be sustained

despite the disruption of conflict?

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Human Resources

Health as a sector increasingly targeted

Health workforce frequently distorted

Loss through death, injury, relocation, migration

Rural-urban mal-distribution exacerbated

Imbalance between professions increases Quality of training, accreditation problematic

Political imperatives around workforce planning

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Human Resources

How might health personnel,and their capacity, be protected

despite ongoing conflict?

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Financing

Local financing for health frequently reduced

International humanitarian funding for health

may rise exponentially but not sustainably

Health aid often a focus for the military

Post-conflict donor financing contributes to

sectoral reform, but also donor agendas

Issues of appropriate models, sustainability

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Financing

How can we move towardssustainable financing within the imperatives

of international responses to conflict?

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Drugs, Vaccines and Technology

Health in conflict rapidly commodified

Porous borders, limited regulation

Vaccination vulnerable as access and

demand compromised, cold chain disrupted

Free NGO services may compete with local

user-pays state services, private providers

Acute responses may disrupt fragile local

drug procurement economies

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Drugs, Vaccines and Technology

How can we minimize disruption tolocal systemsboth formal and informal

in humanitarian interventions?

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Health Information

HIS frequently vulnerable prior to conflict, but

further compromised:

Loss or relocation of staff responsible for HIS

Disrupted communication, reporting, supervision

Health information is political

Limited available data may distort realities

Rapid appraisals useful but not sustainable

Competing data often confusing, contested

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Health Information

How can we balance the need forsustainable information systems with the

pressures for good enough data now?

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Leadership and governance

Legitimate authority often contested or lost

The reach of the state often truncated, with bulk

of health care provision in non-state sector

Conflict and disrupted social and economic

structures distort state leadership and governance:

Dependence on user-fees, exploitation, abuse

But conflict may offer opportunities for new

leadership and governance

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Leadership and governance

What role might international organizationsplay in promoting more responsible leadership,

more effective governance?

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Health systems in conflict

For health systems, the acute, the immediate,

the unpredictable, the chaotic need to be

managed with the long term in view

Afghanistan rightly decided to add a 9th MDG

peace and security are pre-requisites for

development Post-conflict phase offers a critical opportunity

to address health systems distortions of violence