Thursday, January 15, 2015

Disaster Management: Post-Disaster Health System Strengthening

Recovery, as was stated in an early post, is the longest, least-researched and often most neglected part of the disaster management process. Yet, it is profoundly important.  The resources allocated to the acute emergency phase cannot go on indefinitely as that would be unsustainable.  As a result, a large proportion of the humanitarian aid (foreign and domestic) will eventually be withdrawn, leaving the local networks, including the health system, to cope with what is left of the recovery and hopefully return to a relatively normal (non-emergency) level of functioning (this could be similar to the situation pre-disaster but ideally it will be better than before).

Health systems encompasses any institutions, organisations, businesses, bodies, products, resources and/or professionals involved in providing health services.  These include:
  • Governing bodies and those leadership roles
  • People, actions and systems involved in service delivery
  • Health professionals and workforce (i.e. nurses, doctors, midwives)
  • Information systems
  • Medical products and their distributors
  • Vaccines
  • Technology
  • Finances and financial officers
(Dunham 2014; WHO 2008)

So, what should the goals be of post-disaster health systems strengthening?

From what I can gather, they are many.  However, the primary goal is to return the local health system to a normal functioning state, preferably one that is superior to that before the disaster.  It is also imperative to smoothly transition from having a large humanitarian aid presence back to primarily (or only) local service providers.  This requires that the gaps in services left by humanitarian agencies after they reduce their activity or leave the area all together be filled.  There are a number of things to consider:
  • Firstly, what is the context of the situation?
    • Disaster type, scale and stage
    • Are there complicating factors such as conflict?  If the conflict is ongoing, this will have implications for the recovery process
    • Is there a high risk of a subsequent disaster in the near future?
  • Have the specific exit timelines been formally discussed, established and outlined with the host nation and leaders of the local health systems well in advance so that they know exactly when to expect the foreign aid providers to leave?
    • This will help all parties plan for what will need to happen when the aid will slow down and stop so that local services can prepare to fill any gaps and adjust accordingly
  • Are there a sufficient number of locally-operated health institutions in good working condition to provide care?
    • Damaged institutions have been sufficiently repaired
    • Extraneous health units have been gradually closed while populations were informed well in advance and provided with/directed to suitable, locally-run alternatives for their continuing needs
  • What is the situation regarding health staff?
    • Sufficient number of nurses, doctors and midwives for the population
    • The potential inclusion of individuals trained in short courses to respond to the disaster has been dealt with (whether or not to include them and if so in what capacity)
    • The potential for continued education and training of health staff has been explored and formal programs have been implemented wherever possible
    • Networks established between health professionals (for sharing information, providing support, etc) are able to continue.
  • Are appropriate, effective and uniform health information systems operational?
    • Temporary information systems put in place during the disaster have ceased or been incorporated into an official, trusted and established information system
  • Are drugs being supplied through normal, legal and monitored drug channels?
    • Informal/unofficial drug channels used throughout the disaster to fill gaps in access have now been closed
(WHO 2008)

Each of the smaller objectives should ultimately contribute to the overall goal of improving the local health system's capacity to care for its own population and operate autonomously (WHO 2008).  They should also contribute to the strengthening of the area's resilience, in other words, its ability to cope with, adjust and/or bounce back from future disasters (WHO 2008).  Any opportunities that present themselves during the acute emergency response phase to help accomplish these recovery goals (referred to as "foundational activities") should be taken advantage of (WHO 2008).

Unfortunately, funding during the transitional and recovery periods is difficult, especially without clearly defined plans.  I can understand why funding is a problem after the initial relief phase.  The desperation of an emergency, the desire to save people from death and severe injury triggers significantly more action than the rebuilding.  I presume that most donors see funding recovery as an investment in efforts that do not have relatively rapid and/or clear outcomes.  They may also see recovery as a process for which the host nation and local stakeholders should be responsible.


WHO 2008, Health cluster guidance on health recovery, viewed 8 January 2015, <>.


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