When war or disaster strikes a region, restoring health services is a primary concern for governments and aid agencies. In fact, it is so important that many people don’t think projects through before launching them.
However, “if you don’t get things right, particularly for health systems, at the very onset of a humanitarian emergency, it can have long-term consequences in terms of the sustainability of those interventions,” says Valerie Percival, an assistant professor at the Norman Paterson School of International Affairs.
Together with Chantal Blouin, the associate director of the Centre for Trade Policy and Law, Percival co-directs the Health and Foreign Policy Initiative. The objective of the Initiative is to generate and disseminate research to ensure that foreign policy decisions on global health are informed by the best available empirical evidence. Health interventions during and after conflict and natural disaster is one of its focus areas.
High profile humanitarian agencies, such as Médicins Sans Frontières, do not have the time or inclination to conduct long-range planning. Their priority is to immediately treat those with life-threatening injuries and illnesses, and to provide food, water and shelter to reduce the population’s vulnerability to death and disease.
Yet poorly planned health care interventions can have an expensive legacy. Percival worked for several years in Kosovo with the Canadian International Development Agency and the International Crisis Group. She points to a prosthetics lab that the Government of Italy built in the wake of that region’s civil war. “It was beautiful, but after the Italian government stopped its financial support, the Kosovo government would not be able to fund the recurrent costs of the lab.”
Ensuring health services are culturally appropriate is also critical. For example, a health centre in Kosovo provided services for victims of sexual violence. Women could access these services by going to a designated room to discuss their case. But “in societies like Kosovo, where there’s such a code of honour regarding women and sexuality, a woman cannot self-identify by going to a room so that everybody in the community would know she had been raped,” says Percival. “If they had spent five minutes talking to women in the community, they would have realized that that was an inappropriate way to deliver those kinds of services.”
Every situation presents unique challenges. When the earthquake struck Haiti, the country was slowly emerging from a long period of political turmoil. Port au Prince, the centre of government as well as the headquarters of multilateral and non-governmental organizations, was the hardest hit. “I find it hard to think of another natural disaster where… the capital city was so badly affected and the government and international organizations were initially almost paralyzed,” says Percival.
Wars and disasters—devastating as they are—can provide governments an opportunity to improve services. In Haiti, “Now is the time to start thinking about how to rebuild the ministry of health, how to make sure the officials are well trained and have the kinds of resources that they need to ensure Haiti’s health system can be effective and equitable.”
Effective efforts don’t have to be complicated, yet they do have to take into account local context and capacity. More research is needed on the impact of humanitarian assistance on health systems and the most effective ways to leverage humanitarian interventions to build local health system capacity.
The Health and Foreign Policy Initiative is about much more than research on health and conflict. Chantal Blouin examines the migration of health workers, the impact of trade agreements on national health systems, and the use of global health diplomacy to enhance prevention efforts for chronic diseases.
With a $400,000 grant from the Rockefeller Foundation, the Initiative also produces The Health Diplomacy Monitor. This online publication analyses international health negotiations, such as the recently concluded discussions at the World Health Organization on counterfeit medicines, WHO’s response to the H1N1 pandemic, and the voluntary international code for the recruitment of health workers.
These negotiations have a critical impact on global health. But due to small budgets prohibiting travel as well as lack of open-access reporting on the negotiations, officials and civil society groups from developing countries may find it difficult to participate fully or keep abreast of developments. The Monitor will level the playing field and help them to stay involved from a distance.
It’s just another way of carrying out the Health and Foreign Policy Initiative’s main objective: to improve global health for people who can’t always fight for their own interests.