Fragile Environments

This publication sets out to examine the major challenges for indigenous peoples to obtain adequate access to and utilization of quality health care services. It provides an important background to many of the health issues that indigenous peoples are currently facing. Improving indigenous peoples’ health remains a critical challenge for indigenous peoples, States and the United Nations. [from forward]

Research on “human resources for health” (HRH) typically focuses on the public health subsector, despite the World Health Organization’s inclusive definition to the contrary. This qualitative research examines the profile of HRH in six conflict-affected contexts where the public health subsector does not dominate healthcare service provision and HRH is a less coherent and cohesive entity: Afghanistan, the Central African Republic (CAR), the Democratic Republic of Congo (DR Congo), Haiti, the Occupied Palestinian Territories and Somalia. [from abstract]

This manuscript describes the quality of intrapartum care provided by SBAs [Skilled Birth Attendants] in Mae La camp, a low resource, protracted refugee context on the Thai-Myanmar border. [from abstract]

No study to date has focused on how the decisions made, or not made, in the post-conflict
period can affect the longer term pattern of attraction, retention, distribution and
performance of health workers, and thus ultimately the performance of the sector. [from abstract]

Provision of reproductive health (RH) services is a minimum standard of health care in humanitarian settings; however access to these services is often limited. This systematic review, one component of a global evaluation of RH in humanitarian settings, sought to explore the evidence regarding RH services provided in humanitarian settings and to determine if programs are being evaluated. [from abstract]

As part of a larger research project that explores whether and how gender equity considerations are taken into account in the reconstruction and reform of health systems in conflict-affected and post conflict countries, we undertook a narrative literature review based on the questions “How gender sensitive is the reconstruction and reform of health systems in post conflict countries, and what factors need to be taken into consideration to build a gender equitable health system?” We used the World Health Organisation’s (WHO) six building blocks as a framework for our analysis; these six b

Definitions of fragile states focus on state willingness and capacity to ensure security and provide essential
services, including health. Conventional analyses and subsequent policies that focus on state-delivered essential services miss many developments in severely disrupted healthcare arenas. The research seeks to gain insights about the large sections of the health field left to evolve spontaneously by the absent or diminished state. ]from abstract]

The world is witnessing the unprecedented unfolding of the West African Ebola epidemic. The epidemic could have major ramifications for global public health in ways that no other modern infectious disease has, perhaps including AIDS, and can be viewed as a “Black Swan” event. What we call here a Black Swan (and capitalize it) is an event with the following three attributes. First, it is an outlier, as it lies outside the realm of regular expecta- tions, because nothing in the past can convincingly point to its possibility.

With this aim, the study looks at the development of policies on human resources for health (HRH) in Sierra Leone over the decade after the conflict (2002–2012). [from abstract]

Case studies on the HIV response in South Sudan, Haiti and Cote d’Ivoire. [from introduction]

This report offers a review of the rich and varied discussions that took place during the course of the 3-day
conference that resulted in a Call for Action, including a global research agenda.[from introduction]

This report is an analysis of the effects of public health message volume/frequency to health workers during large scale emergencies on recall of specific message content and effect of rate of message communications on health care provider alert fatigue. [adapted from abstract]

This study is based on findings of an investigation of the experiences of Australian disaster workers from a range of health-related fields who provided humanitarian relief in disasters, complex emergencies, conflict and post-conflict situations internationally. [from abstract]

The following paper is a synthesis of the findings of researchers on training transfer and efficacy of the Sexual and Reproductive Health Program in Crisis and Post-Crisis Settings in the Asia Pacific Region, which was designed to address sexual and reproductive health in all phases of the disaster cycle, with a particular focus on preparedness and coordinated response and the importance of human resources for an effective response. [adapted from abstract]

The main objective of this study is to explore the knowledge, attitudes, behaviors and the response capacity of primary care medical staff related to public health emergencies in Guangdong Province, China. [adapted from abstract]

This call to action advocates for the recognition of the economic and social value of volunteers in public health disaster situations and the development of policies to protect them.

This document outlines the important role health workers play in areas suffering from severe crises and makes the case for investing in HRH as central to health system recovery and improved health outcomes. [adapted from author]

Health workers along with other community members and service providers are central to preparing for, and responding to, public health emergencies (PHEs). This policy note presents key considerations for dealing with HRH and PHEs. [from author]

This policy note outlines the importance of the health workforce in public health emergencies (PHEs), highlights the causes of PHEs and the subsequent impacts on the health worker and health system, and raises questions around health workforce performance in PHEs. The focus is on developing country contexts. [from introduction]

The purpose of this paper is to present a comprehensive, engaging, and visible framework of HRH system development. This has been further developed from the lessons distilled from Japanese experiences of supporting HRH system development in three fragile and post-conflict health systems: Afghanistan, the Democratic Republic of Congo, and Cambodia. [from author]

This presentation discusses the impact of public health emergencies on the health workforce and planning needs for addressing it.

The aim of this statement is to draw attention to the vital role that the community-based health workforce plays in all phases of emergency risk management; promote the scale-up of the community-based health workforce; and encourage governments and supporting partners to reinforce the community-based health workforce by strengthening and preparing existing health systems. [from author]

This report links the high rates of maternal mortality with the health worker crisis in fragile states1. It explores the causes of maternal death, highlighting where and why these deaths are occurring. It also contrasts the need to fund health workers and strengthen health systems with the present aid allocations to health. [from author]

This paper captures the professional, personal and national effects conflict is having on health workers and the inadequate protection they currently work under. It explores the context in which health staff are working in some of the world’s most fragile countries. It outlines the high rates of death and disease and the vital role health workers play in not only addressing these needs, but in meeting global health targets. [from introduction]

This report is based on findings of a study that analysed the opinions and experiences of Australians who provided humanitarian relief following disasters, in complex emergencies and wars. The issue of human resources within the humanitarian sector is now unquestionably on the agenda, and the identification of important gaps in knowledge within this field is the central thrust for the study which investigated Australian disaster workers from a broad range of health-related fields. [adapted 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]

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]

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]

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]