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Peter Hill - Health Systems in Disrupted Environments

Peter Hill - Health Systems in Disrupted Environments

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Published by ICRCinLondon
Queensland University's Peter Hill on the impact of violence on health systems
Queensland University's Peter Hill on the impact of violence on health systems

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Categories:Types, Research
Published by: ICRCinLondon on Apr 26, 2012
Copyright:Attribution Non-commercial


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Health systems in conflict: the distortion of violence

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

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

The research
• ‗Health Systems in Severely Disrupted Environments‘ funded by Danida • Six country case-studies: Afghanistan, Central African Republic, Democratic Republic of Congo, Haïti, Palestine, Somalia • Experienced Post-Conflict researchers • Field sites, interviews, documentary analysis

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

Health Services

What strategies might enable public health programs to be sustained despite the disruption of conflict?

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

Human Resources

How might health personnel, and their capacity, be protected despite ongoing conflict?

• 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

How can we move towards sustainable financing within the imperatives of international responses to conflict?

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

Drugs, Vaccines and Technology

How can we minimize disruption to local systems—both formal and informal— in humanitarian interventions?

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

Health Information

How can we balance the need for sustainable information systems with the pressures for ‗good enough‘ data now?

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

Leadership and governance

What role might international organizations play in promoting more responsible leadership, more effective governance?

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

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