Health service delivery in fragile states lessons from the field
This presentation is the property of its rightful owner.
Sponsored Links
1 / 55

Health Service Delivery in Fragile States: Lessons from the Field PowerPoint PPT Presentation


  • 31 Views
  • Uploaded on
  • Presentation posted in: General

Health Service Delivery in Fragile States: Lessons from the Field. Emmanuel d’Harcourt International Rescue Committee Woodrow Wilson Center for Scholars September 12, 2006. Outline. Population and fragility Fragility and health Health and fragility Missions, health, and fragility.

Download Presentation

Health Service Delivery in Fragile States: Lessons from the Field

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Health service delivery in fragile states lessons from the field

Health Service Delivery in Fragile States:Lessons from the Field

Emmanuel d’Harcourt

International Rescue Committee

Woodrow Wilson Center for Scholars

September 12, 2006


Outline

Outline

  • Population and fragility

  • Fragility and health

  • Health and fragility

  • Missions, health, and fragility


Outline1

Outline

  • Population and fragility

  • Fragility and health

  • Health and fragility

  • Missions, health, and fragility


Health service delivery in fragile states lessons from the field

… The [demographic] "wolf" is present and very busy indeed—in Rwanda. … When its population had reached 7.6 million in 1994, observers there were expecting disaster any day in the form of random violence or famine … Rwanda is demographically trapped in that it has exceeded its carrying capacity … Meanwhile, slaughter is ascribed to human rights violations, and the even more disturbing population pressure of demographic entrapment is conveniently forgotten. Demographic entrapment is so … disturbing that orthodox demography, public health, and UN agencies, particularly UNICEF, maintain a political correctness so correct that the entrapment is never mentioned…

Maurice King, MD.

From AJPH, July 1996


Factors associated with the genocide

Factors associated with the genocide

  • Related to resource scarcity

  • Not related to resource scarcity


Related to resource scarcity

Related to Resource Scarcity

  • Popular discontent due to food scarcity

  • Gain from previous Tutsi “pogroms”

  • Fear of losing land to invading army

  • Joblessness


Rwanda population 1900 2000

Rwanda population, 1900-2000

Source: US Census Bureau


Average land holding 1960s 1990s

Average land holding 1960s-1990s

Source: Uvin, 1996


Food production per capita 1961 1993

Food Production per Capita 1961-1993

Source: FAO, 1994


Health service delivery in fragile states lessons from the field

Over-population

Resource scarcity

Popular discontent

Desire

Ability

Permission


Population density

Population density

Source: PRB


Population density1

Population density

Source: PRB


Not related to resource scarcity

Not Related to Resource Scarcity

  • Falling commodity prices

  • Popular discontent due to mismanagement

  • Elite worried about losing power

  • Long tradition of social division

  • Genocidal ideology

  • Effective propaganda and media

  • Highly disciplined state machinery

  • Lack of filial bonds: state vs. tribe

  • International inaction


Coffee earnings 1985 1993

Coffee Earnings, 1985-1993

Source: FAO, 1994


Health service delivery in fragile states lessons from the field

Unfavorable terms of trade / structural adjustment

Over-population

Arusha

Steady arms supply

Rebel attack

International Inaction

Resource scarcity

Corruption

Highly organized state

Social divisions

Popular discontent

Elite insecurity

Lack of filial bonds

Effective media

Desire

Ability

Permission


If population is so important

If population is so important

Source: PRB


Outline2

Outline

  • Population and fragility

  • Fragility and health

  • Health and fragility

  • Missions, health, and fragility


How fragility affects health

How fragility affects health

  • Security

  • Policies

  • Motivation

  • Training

  • Management

  • Sustainability

  • Communities

  • Responsibility


Children treated rwanda and sierra leone

Children treatedRwanda and Sierra Leone


Amodiaquine s p

Amodiaquine + S/P


Outline3

Outline

  • Population and fragility

  • Fragility and health

  • Health and fragility

  • Missions, health, and fragility


How health affects fragility

How health affects fragility

  • No services is a big part of fragility


How health affects fragility1

How health affects fragility

  • No services is a big part of fragility

  • Good services legitimize governments


Cost per treatment

Cost Per Treatment


How health affects fragility2

How health affects fragility

  • No services is a big part of fragility

  • Good services legitimize governments

  • Health is entry point for building systems


Safe motherhood kibungo province

Safe Motherhood, Kibungo Province


Children treated south sudan and sierra leone

Children treatedSouth Sudan and Sierra Leone


Children treated south sudan and sierra leone1

Children treatedSouth Sudan and Sierra Leone


South sudan example

South Sudan example

  • Good human resource management

  • Good information system

  • Simple tools

  • Scaleable

  • Adapted to local environment


How health affects fragility3

How health affects fragility

  • No services is a big part of fragility

  • Good services legitimize governments

  • Health is entry point for building systems

  • Systems may induce more responsibility


How health affects fragility4

How health affects fragility

  • No services is a big part of fragility

  • Good services legitimize governments

  • Health is entry point for building systems

  • Systems may induce more responsibility

  • Community work strengthens communities


Distributor information

Distributor Information


Key quality indicators community distributors south sudan

Key quality indicatorsCommunity distributors, South Sudan

n = 96 supervision reports


Can health programs help

Can Health Programs Help?

a

a

  • Poor information

  • Weak human resources

  • Weak absorptive capacity

  • Uncertain future

  • Unpredictable external support

  • Recidivism

  • Need to address immediate needs

  • Need to show peace dividend

a

x

x

x

a

a


Can health programs help1

Can Health Programs Help?

  • Enhance stability

  • Improve security

  • Encourage reform

  • Increase capacity in key areas

  • Address sources of fragility

  • Seek short-term impact & long-term reform

  • Establish measurement systems

a

a

a

a


Institutional indicators from health

Institutional Indicators from Health

  • Utilization rate

  • Reported supervisions / health area / month

  • % community workers reporting

  • % stock out for key drugs


Outline4

Outline

  • Population and fragility

  • Fragility and health

  • Health and fragility

  • Missions, health, and fragility


Health fragility and missions

Health, Fragility, and Missions

  • Missions are concerned about fragility

  • Missions care about health status

  • What do missions do that helps?

  • What do missions do that doesn’t help?


Health fragility and ngos

Health, Fragility, and NGOs

  • Field-based

  • Innovative

  • Collaborative

  • Coordinated

  • Think of scale-up

  • Expensive

  • Short term

  • Small scale

  • Not audited


Things that don t help

Things that don’t help

  • Frequent strategic redesign

  • Process of strategic redesign

  • Little field presence

  • Concentrating resources

  • Lack of DC – Mission coordination

  • Some regulations – drugs, salaries

  • Short-term funding


Things that do help

Things that do help

  • Ambitious programs designed for scale

  • Coordination of grantees

  • Coordinating with other donors

  • Grantee – Government mediation

  • Inter-sector synergy

  • Willingness to support systems

  • Long-term funding


Who has the answer

Who has the answer?

USAID DC

USAID Mission

iNGOs HQ staff

iNGOs local staff

Beneficiaries

National officials

Local officials

Local NGOs


Top 5 recommendations

Top 5 recommendations

  • Think big, think national

  • Focus on coordination and systems

  • Rethink drug procurement limits

  • Rethink salary support limits

  • Rethink strategic planning process

    • Less large shifts, more small adjustments

    • More participation


Ofda recommendations

OFDA Recommendations

  • Switch to long-term funding ASAP

  • Increase monitoring of costs, results

  • Continue focus on inputs


Bottom line

Bottom Line

  • Fragility affects health – a lot

  • Health programs can reduce fragility – some

    • Systems

    • Measurement

  • Health programs can reduce suffering – a lot

  • Missions help, could help even more

    • Stable strategy, stable funding

    • Coordinate


  • Login