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, Hati, 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?

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

Financing
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 systemsboth 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