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
- Finances and financial officers
- 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
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.