Health sector recovery in early post‐conflict environments: experience from southern Sudan

Health sector recovery in post‐conflict settings presents an opportunity for reform: analysis of policy processes can provide useful lessons. 1 The case of southern Sudan is assessed through interviews, a literature review, and by drawing on the experience of former technical advisers to the Ministry of Health. In the immediate post‐conflict phase, the health system in southern Sudan was characterised by fragmentation, low coverage of health services, dismal health outcomes and limited government capacity. Health policy was extensively shaped by the interplay of context, actors and processes: the World Bank and the World Health Organization became the primary drivers of policy change. Lessons learned from the southern Sudan case include the need for: sustained investment in assessment and planning of recovery activities; building of procurement capacity early in the recovery process; support for funding instruments that can disburse resources rapidly; and streamlining the governance structures and procedures adopted by health recovery financing mechanisms and adapting them to the local context.     

Post-conflict health reconstruction: search for a policy

Despite increasing experience in health reconstruction in societies emerging from conflict, the policy basis for investing in the development of equitable and effective health systems in the wake of war remains unsettled. Consideration of post-conflict health reconstruction is almost entirely absent in donor policies on global health. Practically by default, health programmes are seen increasingly as an element of stabilisation and security interventions in the aftermath of armed conflict. That perspective, however, lacks an evidence base and can skew health programmes towards short-term security and stabilisation goals that have a marginal impact and violate the principles of equity, non-discrimination, and quality, which are central to sound health systems and public acceptance of them. A better approach is to ground policy in legitimacy, viewing health both as a core social institution and one that, if developed according to human rights principles, including equity, non-discrimination, participation and accountability, can advance the effectiveness and the quality of governance in the emerging state.     

An integrated approach: managing resources for post-disaster reconstruction

A lack of resources for post-disaster housing reconstruction significantly limits the prospects for successful recovery. Following the earthquake in Wenchuan, China, in May 2008, housing reconstruction was not immune to resource shortages and price inflation. Difficulties in sourcing materials and labour considerably impeded recovery. This paper provides evidence of the resourcing bottlenecks inherent in the post-Wenchuan earthquake reconstruction process. Its aim is to present an integrated planning framework for managing resources for post-disaster housing rebuilding. The results are drawn from in-field surveys that highlight the areas where stakeholders need to concentrate effort, including revising legislation and policy, enhancing capacity for rebuilding in the construction industry, strengthening the transportation network, restructuring market mechanisms, and incorporating environmental considerations into overall planning. Although the case study presented here is country-specific, it is hoped that the findings provide a basis for future research to identify resourcing constraints and solutions in other disaster contexts.     

Implementing cash for work programmes in post-tsunami Aceh: experiences and lessons learned

Cash for work (CFW) programmes are utilised in various disaster and emergency contexts and were a prominent component of the tsunami response in Aceh province, Indonesia. This paper describes Mercy Corps' CFW programme, discusses CFW implementation experiences and provides key recommendations for similar programmes in future emergencies. For the majority of CFW participants and their households, CFW was the only source of household income and 93 per cent of household incomes were attributable to it. The CFW programme empowered displaced populations to return to their communities; 91 per cent of participants indicated that CFW facilitated their return. Other reported psychosocial benefits included providing productive activities and giving communities an opportunity to work together. Mercy Corps' experience in Aceh demonstrates that cash disbursements can be safely delivered in a widespread manner in emergencies, and that when implemented on a short-term basis, can have positive impacts at the individual and community level.