GHF2010 – PS25 – Rebuilding Post-Conflict Health Systems: Challenges and Opportunities

Session Outline

Parallel session PS25, Tuesday, April 20 2010, 16:00-17:30, Room 2
Chair(s): Yves Etienne, Head, Assistance Divisions, International Committee of the Red Cross, Switzerland, Davide Mosca, Director, Migration Health Department, International Organization for Migration, Switzerland
Ethics in the Delivery of Humanitarian Health Assistance: Learning from the Narratives of Health Workers
Lisa Schwartz, Clinical Epidemiology and Biostatistics, McMaster University, Canada
Managing a Health Crisis with Limited Health Systems Capabilities
Lenias Hwenda, Executive Education, IHEID, Switzerland
Health Sector Support: A Bridge to Peace in the Northern Caucasus
Khassan Dzgoev, Lecturer, Department of Surgery, State Medical Academy, Vladikavkaz, Russian Federation
Ensuring Provision of Appropriate Physical Rehabilitation Services: From Emergency to Long-Term
Claude Tardif, Head of Physical Rehabilitation Programmes, Health Unit, Assistance Division, International Committee of the Red Cross, Switzerland

Session Documents

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Session Video

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Session Report

Submitted by: James Reynolds-Brown (ICVolunteers); Contributors: Josefine Ridderstrale (ICVolunteers)

Theo Verhoeff of ICRC. Photo by V. Krebs, ICVolunteers.org

A series of short presentations covering the increasingly complex work of following immediate crisis response with effective capacity building systems. Case studies from the North Caucasus, Afghanistan and from the recent experience of the ICRC highlight the issues involved and various attempts to address them.

Yves Etienne and Davide Mosca chaired this series of presentations looking at the longer term implications for health systems in the short and long post-conflict terms. Mr Etienne, setting the tone for the rest of the presentations, reminded the audience of the difficulties in making the link between an emergency situation and reconstruction phases. A new paradigm of chronic-crisis situations, where the ICRC and similar agencies found it difficult to tell whether a conflict situation had ceased or simply paused, was emerging.

Lisa Schwartz of McMaster University gave a presentation on dealing with ethical and moral distress in returning health workers. Her team’s study of several health workers had uncovered ethical challenges where no response to a situation would be without a moral dilemma. Covering her slides in detail, Dr Schwartz noted four main themes from her research as the cause of moral and ethical distress: resource scarcity, social inequities, the policies and agendas of aid agencies, and the roles and interactions with western norms. Her recommendation for the future was to find a new approach to pre-deployment training and providing support for moral distress and the ability to talk about it.

A comment from the audience pointed out that it took courage to dig into these ethical issues, and suggested that the role of impartiality should also be built into any new approach for pre-deployment training. The audience member also agreed with the notion that the creation of ‘space’ for health professionals was key.

Khassan Dzgoev gave a view on health sector support as a means to achieving and embedding peace in the North Caucasus, a region of recent armed conflict. Each of the three republics, North Ossetia, Chechnya and Ingushetia, had suffered serious problems with their health systems, consisting of underfunding, destruction of services, poor laboratory quality, lack of professional training, and problems diagnosing TB/HIV. The Swiss Agency for Development and Cooperation (SDC) had focussed on these areas and produced several steps for improvement. Laboratory services had been strengthened or re-established, a DOTS strategy had been implemented, training had been provided, and prevention/prophylactic services had been enhanced. A key element of the work had been cooperation between the three republics, especially in the fields of training, ministerial effort and medical collaboration. The work of a trusted third party, competent professionals, and a clear focus on health concerns had been some of the most important success factors.

Yves Etienne agreed with the principle of Dr Dzgoev’s talk in stating “health should be stronger than politics”.

The work of the International Committee of the Red Cross (ICRC) in long-term physical rehabilitation projects was covered by Theo Verhoeff. The ICRC, in recognising that those with physical disabilities arising from conflict situations needed assistance in social integration and medical support beyond the conflict phase, sought to address their long term needs through access to rehabilitation services; the ‘physical rehabilitation continuum’. The ICRC had established the Special Fund for the Disabled (SFD), to complement the work of its Physical Rehabilitation Programme (PRP). Although the main objectives of the PRP and SFD are the same, their respective responsibilities are different. The PRP substitutes itself for the national authority, while the role of the SFD is just to support the re- or newly-established national authority. Giving some statistics, Mr Verhoeff noted that the PRP had 90 projects in 25 countries, and the SFD had 64 projects worldwide. He summed up by noting that the SFD can help embed physical rehabilitation programmes, the help is appreciated by all parties including donors, that sustaining services is a challenge, and that success depends on the commitment of nations, organisations and donors.

Yves Etienne noted that once a programme, such as the provision of prosthetics to children, had started, many organisations found it difficult to end that programme and had not considered the need for near permanent involvement in the programme; the work of the SFD was key to sustainability.

For the final session, Pierre Gauthier preceded a short film, ‘A new life for Mohsin’ with some pithy words. Echoing the other presenters, he noted that providing patient services is not enough, you have to consider the social integration of a patient. The ICRC had sought to institutionalise this in various projects, including this particular one in Kabul. The film, about social integration in Afghanistan, covered the work of an ICRC unit in Kabul in rehabilitating patients and providing for their re-integration into their family and the wider society. They were able to provide micro-credit, home based support services and had established a local workshop for the production of mobility aids.

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