Health Development and Programming in Conflict and Post-Conflict States

CONTENTS:

The papers in this series are the products of work undertaken by the U.S. Agency for International Development’s Bureau for Global Health, Office of Health, Infectious Diseases and Nutrition, with technical assistance provided by USAID/BASICS in collaboration with the Bureau for Democracy, Conflict and Humanitarian Assistance/Conflict Management & Mitigation, and the Organisation for Economic Co-operation and Development/Development Assistance Committee. This effort was part of a multi-donor exercise to deepen our understanding of health programming in post conflict and fragile environments.

In many cases, programming will require adaptation of health approaches so that they address key stabilization and resconstruction needs as well as public health needs. The increased importance of countries in or emerging from conflict within the broader context of instability and terrorism all demand special attention in order to develop a better approach to health sector actions within this larger scope.

A number of compelling recommendations for health programming in fragile states are presented by the authors of this series. As suggested by Ron Waldman in Health Programming in Post-conflict Fragile States, there are essential common features to recognize. A useful way to understand these commonalities is to compare the three case studies provided in this series: Democratic Republic of the Congo, Southern Sudan, and Northern Uganda. In particular, each assesses the critical balance that needs to be struck—and the tension that exists—between programming to meet the emergency needs of a fragile state’s population and programming aimed at building sustainable capacity in a health care system. An equally important shared theme is the role of donor harmonization in increasing program efficiency, recipient accountability, and coverage.

In Health Service in Early Recovery States, Laurie Zivetz notably summarizes (pages 33 and 34) helpful and unhelpful trends in assistance to fragile states, followed by a planning framework that emphasizes the proper sequencing of activities. A challenging rejoinder to this approach to program planning is offered by Ron Waldman, again in Health Programming in Post-conflict Fragile States. Citing evidence that improved security in a country is the most effective means to reduce excess mortality because it creates a favorable environment for health service delivery, he suggests that disease control programs need to be appropriately designed and implemented with non-disease control objective in mind, as well.