Fragile Environments

Task shifting is one avenue for delivering needed health care in resource poor settings, and on-the-ground reports indicate that task shifting may be applicable in humanitarian responses to natural disasters and conflicts. This report evaluates the potential strengths and weaknesses of task shifting in humanitarian relief efforts, and proposes a range of strategies to constructively integrate task shifting into humanitarian response. [adapted from abstract]

In countries where conflict-related and gender-based violence is taking place, the health sector can contribute by providing essential medical interventions and support for survivors, documentation for legal cases, programs that assist in reducing social stigma, and data for effective programming. [from summary]

Nowhere is the global health worker crisis more acute than in fragile states – those countries where the government cannot or will not deliver core functions to the majority of its people. Since the civil war, Liberia has an absolute shortage of health workers. Merlin is working with the government to help train health workers and rebuild the shattered health system. [from author]

With some of the worst health indicators and the least adequate health services in the world, providing health services and rebuilding health systems in fragile states is a complex undertaking. This health and fragile states dossier highlights the challenges and approaches to delivering health services in fragile states. [from publisher]

The Trauma Management Program (TMP) was developed to improve the capacity of local health workers to deliver effective trauma care. This report illustrates a method to increase the capacity of indigenous health workers to manage traumatic injuries. These health workers are able to provide trauma care for otherwise inaccessible populations in remote and conflicted regions. The principles learnt during the implementation of the TMP might be applied in similar settings. [from introduction]

This presentation was from the “Health Service Delivery in Fragile States for US$ 5 perperson per year: Myth or Reality?” conference. It discusses the limited public sector capacity to deliver priority services in fragile states and the opportunities and challenges of using non-state providers to increase coverage. [adapted from author]

This resource is a chapter from Disease Control Priorities in Developing Countries. Despite the best efforts of primary care providers and public health planners, not every emergency is preventable. Actual provision of emergency care may range from delivery using trained emergency professionals to delivery by laypeople and taxi drivers. Developing strategies to meet the range of needs posed by such diverse circumstances will require innovation and a reorientation of public health planning. [from introduction]

The Central America Field Epidemiology Training Program (CA FETP) is a public health capacity-building training programme aimed at developing high-caliber field epidemiologists at various levels of the public health system. The curriculum is competency-based, and is divided into a three-tiered training pyramid that corresponds to the needs at the local, district and central levels of the health system.[adapted from abstract]

This presentation from the 2008 Asia-Pacific Action Alliance on Human Resource for Health Conference discusses the need for the development of a disaster management course for healthcare workers in Sri Lanka.


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This article discusses the requirements for improving the experience of health care workers in fragile states. Efforts are needed to establish performance-management systems, to support promotion based on merit, and to provide wider opportunities for professional development. These efforts must be accompanied by measures to restructure the workforce (in some cases radically), thus matching staffing levels with agreed norms and to redress imbalances between rural and urban areas and between different levels within the system. [adapted from author]

This report describes how the war in Iraq and its aftermath continue to have a disastrous impact on the physical and mental health of the Iraqi people, and the urgent measures needed to improve health and health services. It assesses the current state of the health system, including the impact of insecurity, and the workforce, supplies, medicines and equipment it lacks. It also looks at health information and health policy in Iraq. The report ends with conclusions and recommendations, exploring what needs to happen now in Iraq and what lessons can be learned. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It discusses training Clinical Officers, a cadre of mid-level health professionals, as a method of filling the health worker gap in a post-conflict area.

It has become urgent for health agencies and related public services to collaborate, and for all health professionals to become knowledgeable about disaster preparedness. Crisis management, which has become more prevalent for many organizations, is an important strategic initiative for nursing, helping them provide the infrastructure to respond effectively to emergencies and unpredictable events. It is important in today's world that hospital and nursing organizations develop a strategic system to handle disaster situations. [from abstract]

The challenges inherent in planning, developing and supporting a sustainable health care workforce are all the more difficult in countries where conflict or the aftermath of conflict can impede the implementation of short- and long-term approaches to building human resources for health (HRH). Based on field experiences implementing programs in such situations and supplemented by a carefully targeted literature review, this resource paper explores operational challenges, opportunities and goals common to initiating HRH programs in conflict and post-conflict situations. [introduction]

The 2005 peace treaty between the government of Sudan and the Sudan People’s Liberation Army created a window of opportunity for rebuilding the south’s severely damaged health sector. The effort is getting an important boost from a program to bring back 15 Sudanese-born doctors who are ready to help. [adapted from author]

This paper discusses how Mozambique coped with the health system needs in terms of specialized doctors since independence, in a troubled context of war, lack of financial resources and modifying settings of foreign aid. The Ministry of Health (MOH) managed to make up for its severe scarcity of specialist MDs especially through contracting expatriate technical assistance.

People caught in crisis situations have crucial reproductive health needs. The needs of pregnant women are most urgent. Complications of labor and delivery can be life-threatening when women lack adequate care. Risk for HIV/AIDS, other STIs, and unwanted pregnancy increases, particularly when disorder provides cover for rape and other sexual coercion. Health care providers understand people’s needs and have experience meeting them, but few have worked in humanitarian relief.

This analytical report is conducted to measure the gap between the available staffing resources of health services in greater Darfur and the identified minimum standards to be attained in disaster assistance. Key indicators of staffing levels (i.e. home visitors, doctors, health workers, ORT, etc) are used to measure these standards. Different levels of PHC system (i.e. community level, peripheral health facility, central health facility, and referral hospital level) are presented to show the coverage of the medical staffing resources per states on locality levels. [author’s description]

The document aims to analyse the health system in Sudan, to identify the new challenges brought about by the new context, and on this basis to present a post-conflict strategic framework for the health sector. Chapter 3 presents an overview of the health sector. Available data on infrastructures and human resources indicate wide inequality across states in resource availability. The findings of sub-sector reviews consistently point to the overall low technical and managerial capacity at local level, the lack of recurrent funds and the high attrition of health workers, due to low salaries and difficult working conditions. [from executive summary]

This paper seeks to elucidate HRH issues in the critical startup period of reconstruction in countries that have experienced relatively prolonged and major conflict. The examples are drawn mostly from Afghanistan and Cambodia, two countries that experienced more than twenty years of conflict. [from author]

An honest and critical examination of the role of Health Care Professionals (HCPs) during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. [summary]

Functioning health services are key to making the community of New Orleans livable again. Conversely, a livable community is key to attracting a stable healthcare workforce to New Orleans. Hurricane Katrina forced the entire healthcare workforce to evacuate the City of New Orleans and a large majority of these workers have since found jobs elsewhere, such as in neighboring parishes and Texas. This brief summarizes policy options to create and maintain a healthcare workforce, as well as options to bridge the transition from the current situation to the point at which the interventions will show an effect.

Designed to assist in re-establishing health services in a context of political and economical instability, this guide provides practical information and tools for rebuilding a health workforce, as well as examples from post-conflict countries. [publisher’s description]