Health and Conflict: Eight Perspectives on Ways to Move Forward

The BASICS (Basic Support for Institutionalizing Child Survival) Project hosted a symposium in Washington, DC, on September 30, in which government officials and experts shared their experiences of health care issues in conflict and postconflict states. The symposium brought together eight speakers who discussed the importance of planning; the need to coordinate ministries of health, donors, and nongovernmental organizations; and the importance of linking action to a government’s own national strategies in health and development. Views on civilian and military cooperation in rebuilding health systems constituted the first part of the symposium; the second part provided perspectives on implementation issues in difficult situations.

Rebuilding Health Systems

Gene Bonventre of the Center for Strategic and International Studies kicked off the first part with a perspective on “humanitarian space” as a shared space. He explained that, under international law, all parties to a conflict carry the responsibility to protect vulnerable populations and “preserve and protect civilian health capacity during combat.”

The Senior Country Affairs Officer on the U.S. Agency for International Development (USAID) Afghanistan–Pakistan Task Force, Carl Abdou Rahmaan, emphasized involving conflict states in their health programming. He explained that Pakistan is a good example of the need to do more through the host government. Rahmaan said, “USAID in Pakistan is shutting down a number of programs so they can refocus to have more engagement” with key actors in the country.

The Deputy Coordinator for Reconstruction and Stabilization of the U.S. Department of State, Robert Jenkins, used the metaphor of a relay race to stress the need for “fast action focused on immediate priorities.” To be able to exchange the figurative baton between relief and development “runners” without dropping it, he explained, a plan must be in place along with a “whole-of-government response” to ensure that people start running at the appropriate time. Jenkins asserted that “we have to start the longer term health activities right away” to meet people’s expectations and then take advantage of the opportunity that improved security brings.

Implementation Issues

In the second half of the session, Enrico Pavignani, World Health Organization advisor on postconflict countries, drew on the examples of Cambodia, Kosovo, Mozambique, and Uganda to point out the need to establish a balance between quick fixes and systemic approaches to humanitarian crises.

Tim Challans, a military planner, spoke about rebuilding rather than repairing health systems.

S. Tornorlah Varpilah, Deputy Minister for Planning, Research, and Vital Statistics in the Ministry of Health and Social Welfare of Liberia, offered lessons and achievements from his country’s experience with rebuilding, in which BASICS played a major role. Those lessons include leadership, participation, and capacity-building. Not only has Liberia developed a basic package of health services and a national health plan—as well as a policy that identifies its priorities—but it also has ramped up training and education of health workers.

Gary Cook of USAID took note of the need to sustain progress made in Afghanistan, both in strengthening the health system and delivering community-based services, in the face of heightened security problems.

In his presentation, Bill Newbrander of Management Sciences for Health (MSH) identified what efforts have worked in postconflict countries, why they worked, what is required for success and the tools that have assisted these efforts, and how to prioritize actions in such countries. Newbrander offered the following concluding remarks:

  • Health system strengthening is the essential response to countries in conflict and postconflict.
  • Robust solutions based on evidence are needed in these difficult situations.
  • Lessons from our experience apply to health development and, more generally, to systems strengthening.
  • Donor coordination and harmonization with the host government in charge are essential for development.
  • Solutions should be flexible, so that countries can determine their own needs and priorities rather than having a “one size fits all” approach in these fragile states.

BASICS has been the USAID’s flagship child survival project for the past 15 years and consists of a partnership of six organizations, of which MSH is the managing partner. BASICS assists USAID in addressing health systems development and child health in fragile states, including Afghanistan, Cambodia, Liberia, southern Sudan, and Timor Leste.

The materials from this event, including slides and audio recordings, are available on the BASICS website. The site also provides PDFs of 12 papers on BASICS’ experiences in conflict and postconflict environments.