Research for stronger health systems during and after crisis

Rebuilding after catastrophe? A missed opportunity for health and social change

Posted on Tuesday, 16 Feb 2016

Photo: Villagers in earthquake-hit Chautara in Sindhupalchok District – north east of Kathmandu, Nepal (Courtesy: Jessica Lea/DFID)

Rosalind Steege reflects on the challenges of addressing long-term development during humanitarian responses, following a recent panel discussion hosted by The Guardian.

Over the past 2 years Ebola has taken the lives of over 11,000 people, and recent events show that it still threatens the lives of those in Sierra Leone. This news serves as a wake-up call for those in the global community who had breathed a sigh of relief, and demands reflection and lesson learning. Ebola is just one of the many crisis the world faced through 2015, which include the Nepal earthquakes, Yemen civil war, South Sudan conflict and the ongoing Syrian refugee crisis to name a few. So, what have we learned on how to rebuild a country after catastrophe?

A recent panel hosted by the Guardian’s Global Development Professionals Network aimed to answer just that. The panel consisted of humanitarian disaster experts from civil society, academia, private sector and the media. I went along to understand how the humanitarian and development community responds to these disasters, and how we can ‘build back better’.

The event opened with a powerful film covering the effects of the recent earthquakes in Nepal and an insight into how communities are not only coping with the aftermath, but rebuilding lives and livelihoods. With climate change likely to contribute to further natural disasters, and a growing population in an ever more connected world, we must be prepared for not only an increase in frequency of humanitarian crises but increasing numbers of those affected.

The discussion, drawing on the wealth of experience from panel members and the audience, unearthed four key takeaways on responding to crises:

1)      Restoring livelihoods should be a priority. With the exemption of epidemics, most lives are typically lost during the disaster; in its wake we should focus on restoring livelihoods. David Alexander took lessons from Haiti, where food came flooding in after the earthquake suppressing farming costs and causing a secondary disaster, and from L’Aquila region in Italy, where following the 2009 earthquake, roughly 16,000 jobs were lost as companies moved out and the economy ground to a halt. This is where the private sector really has a role to play in empowering communities by providing continuity of employment or microloans to help local famers or traders restore their operations following a disaster.

2)      Engaging and working with communities to understand local contexts is at the crux of sustainable development, and even more crucial in the wake of disasters that leave communities weakened long after the world’s media have left. Lewis Sida noted that, “in these situations it is often the local community that helps first so you can’t ignore them – in fact the most effective responses plug in to these capacities”.

Kate Muzwehi highlighted the role of young community workers during the Ebola outbreak as social mobilisers. They ensured communities listened to messages around safe burials and continued this role in the community after aid agencies withdrew. Notably, they were also tasked with holding governments accountable to commitments made, such as health system strengthening. Experience from the COUNTDOWN programme showed how close to community (CTC) providers in Liberia were important agents of social change, helping re-build trust between the health system and communities in the wake of the Ebola crisis.

3)      Rethinking funding for disaster relief may help to alleviate some of the challenges cited by the panel. Ben Webster stressed the need to move away from project-specific funding to a more holistic, long-term funding cycle, with greater accountability to the communities served; for too long political decision-making has driven donor funding rather than country development priorities. Funding allocation for disaster relief is also an issue; while the 2004 Tsunami raised $4.5 billion by the UN, the $30 million needed for the Darfur genocide at the same time could not be raised, and these funds are non-transferrable. The media play a major role in donor decision-making and funding priorities: “Because Yemen, northern Nigeria and Ukraine are not high enough in the media, you can’t raise money. It’s really frustrating when trying to respond on the basis of need. Often, it’s journalists who get there first. Their reporting gives a slant on what the information is, but we need a rounded view.”

4)      Greater co-ordination across the humanitarian sector is required to ensure that effort is not wasted co-ordinating staff and is instead concentrated to help those on the ground. More could also be done to share learning from past relief efforts and to ensure effective handovers to the development community when humanitarian crises are over. Despite large relief budgets Haiti is still developing 5 years after the earthquake, as one Port-au-Prince resident put it “Haiti is an outdoor museum of failed projects”, which begs the question why these mistakes keep being made? Panellists suggested a competitive and blame culture could explain this. What is needed is to foster a culture of learning and reflexivity that can lead to more effective systems being re-built.

While these are four practical strategies to improve our reactions to crises, we must not miss the unique window of opportunity that comes in the wake of a disaster; the opportunity to create social reform, to ‘build back better’. Building Back Better, which links research from the SIPRI working group on gender and the ReBUILD consortium, illustrates this point with an example from Sierra Leone. The humanitarian response to the Ebola outbreak failed to adequately integrate gender equality advocacy strategies in their response, despite the disproportionate effect Ebola had on women in Sierra Leone due to their caring roles – a lost opportunity for a gender-responsive recovery plan within and beyond the health sector.Lewis Sida, when discussing the suggestion to rethink fishing practices following the 2004 Tsunami, confessed that this approach feels unnatural for humanitarian professionals, focussed on the immediate destruction, but if humanitarian aid doesn’t integrate social reform into their work an opportunity for change is missed. This is the change that will take us beyond disaster response to a proactive focus on risk management – building more responsive systems – building back better.

Rosalind Steege is a PhD candidate at the Liverpool School of Tropical Medicine. Her research focuses on the largely unexplored area of close to community (CTC) providers and gender. Rosalind is passionate about research in this area as addressing the gendered needs of the CTC providers, a key cadre in linking health systems and marginalised communities, is critical to ensuring sustainable development and will help move the global health agenda beyond Universal Health Coverage to Universal Health Access.