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.     

Challenges to mobilising resources for disaster recovery and reconstruction: perspectives of the Haitian diaspora

Diasporas and diaspora non‐governmental organisations (NGOs) are increasingly important as resource lifelines to their home countries, yet the resources that they mobilise, the types of challenges that they face, and their coping mechanisms are not well explored or understood in the context of disaster recovery. To fill this knowledge gap, this study employed an inductive qualitative methodological approach, using interviews to comprehend the role played by Haitian diaspora NGOs after the catastrophic earthquake in 2010. It found that resources take four common forms: event fundraisers; financial and material donations from supporters; remittances; and volunteer labour. Challenges include an overreliance on diaspora donors, competition among NGOs, and what is perceived as inequitable funding practices towards diaspora NGOs. The findings provide insights centred on better coordination among diaspora NGOs, as well as between diaspora NGOs and other local and international NGOs and local governments and international institutions, to ensure more efficient delivery of services to survivors.     

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.     

Fieldwork after conflict: contextualising the challenges of access and data quality

Despite sustained scholarly interest in post‐conflict states, there has not been a thorough review and analysis of associated methodology and the challenges of conducting research in these contexts. Addressing this gap, this paper directs attention to the particular effects of these settings on access and data quality and their ramifications for the resulting scholarship. It assesses the intrinsic challenges of performing fieldwork in these environments, drawing on both relevant social science literature and the authors’ experiences of carrying out research in Afghanistan and Timor‐Leste. The study demonstrates that the post‐conflict environment moulds research design and, consequently, influences how questions are answered as well as the questions asked. Moreover, it highlights ways to mitigate these issues. This work is of relevance to scholars planning to engage in field research and to researchers reflecting upon their work, as well as to policymakers who are considering undertaking programmes or commissioning research in post‐conflict areas.     

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.     

Changing tracks as situations change: humanitarian and health response along the Liberia–Côte d'Ivoire border

In recent years, protracted crises and fragile post‐conflict settings have challenged the co‐existence, and even the linear continuum, of relief and development aid. Forced migration has tested humanitarian and development paradigms where sudden‐onset emergencies, violence and displacement arise alongside ongoing development work. Drawing on Médecins Sans Frontières interventions in the region from December 2010 to May 2011, this paper examines aid and healthcare responses to displacement in Côte d'Ivoire and Liberia; it focuses on challenges to the maintenance of preparedness for such foreseeable emergencies and to adaptation in response to changing situations of displacement and insecurity. This ‘backsliding’ from development to emergency remains a substantial challenge to aid; yet, in exactly such cases, it also presents the opportunity to ensure access to medical care that is much more urgently needed in times of crisis, including the suspension of user fees for medical care.     

Learning from the rubble: the case of Christchurch,New Zealand,after the 2010 and 2011 earthquakes

Learning after a disaster is crucial in creating more resilient places. However, many societies are repeatedly overwhelmed by disasters. This can be because of missed opportunities to learn in post‐disaster settings or because of actions implemented that seem to be highly relevant to recovery in the short term, but potentially constrain aspirations in the longer term. This paper assesses learning processes among state and non‐state actors and the ways in which these are bridged and scaled up to wider improvements in governance. Aiming to enrich understanding of post‐disaster learning, it explores different actors’ response actions after the earthquakes in Christchurch, New Zealand, in 2010 and 2011. On the one hand, ‘learning by doing’ is occurring, yet, on the other hand, systemic learning is hindered by mismatches between top‐down steering and bottom‐up initiatives. The study concludes that better linking and synergising of learning processes among different levels is vital for enhancing resilience in post‐disaster societies.