The worst mortality and morbidity rates for women, children and adolescents occur in humanitarian and fragile settings that are caused by, and create, breakdowns in governance, rule of law and support systems. Such settings can be a result of conflicts or natural disasters but can also stem from ongoing political crises and systematic weaknesses. These settings are characterized by destruction or absence of public infrastructure including health facilities, massive population displacement, insecurity and a collapse of the social contract. For example, hostilities may be actively directed at stigmatized populations, and governments may become hostile to displaced populations. And, while climate change threatens everyone, it has become increasingly evident that it brings differential impacts to women, children and adolescents. This requires specific actions putting women, children and adolescents at the centre of humanitarian response and climate change adaptation and mitigation strategies.
In response to these challenges, national health and social systems need to link development and humanitarian programming, seeing both as “core business”. This requires investments in preparedness, local systems building and service provision (including investment in civil society delivery), and community resilience. Governments should also consider how responses to emergencies might strengthen existing systems and/or build capacity where it does not exist, particularly in fragile settings.
A five year implementation plan is being developed for supporting implementation of the Global Strategy in humanitarian and fragile settings; a description is included in the resource list below.
8.1 Humanitarian and fragile settings as core business of national health and social systems
Key steps for positioning humanitarian and fragile settings as core business of national health and social systems include:
- integrating action in humanitarian and fragile settings into national strategies for health and other sectors, with a single planning, monitoring and accountability framework, with inputs from affected communities
- ensuring clarity on jurisdiction and accountability between different ministries and sectors, clearly assigning overall leadership and roles, particularly during humanitarian emergencies
- using assessment tools such as multi-hazard health sector risk assessment (including gender and conflict sensitivity analysis, risk of epidemics and pandemics, and climate-related risk) to understand vulnerabilities in health and social systems
- using a risk-informed programming approach in country development plans, including risk assessments, risk mitigation, disaster planning and contingency funding
- investing in the capacity to absorb shocks to build resilience, through simulations, preparedness and planning for reconfiguration of resources (e.g. workforce), with strategies for response to sudden reduction in capacities
- acknowledging the potential impact of emergencies on proximal and distal health service coverage determinants and outcomes, such as diversion of resources, public security, communications infrastructure, geographic isolation, staff desertion and population movement
- strengthening capacity and data availability to undertake situation analyses in emergencies
- recognizing that capacity building and data strengthening should not only revolve around emergency preparedness, but should also include the perhaps limited but existing local, district and county health data systems.