A doctor conducts a health screening at a health center in Sudan.

2021: Moving Forward But Remembering What We Have Learned

There is a humanitarian-to-development nexus. Can we navigate it better?

Written by Elijah Olivas, with Eric Sarriot and Will Story

As is everyone, we are looking for better things in 2021—among them, to remember some of what we learned last year. And no, this is not about Covid-19, although we are sure some of it will apply.

Just over a year ago, we released two case studies of systems effects of successive Save the Children emergency health and nutrition (EHN) projects (Sudan and Pakistan). And, we recently published a cross-cutting analysis paper in Health Policy and Planning on this topic. This work took over three years to complete, but it provides the opportunity for some reflection, which is worth bearing in mind as we start a new year.

The immense value of asking questions

At the beginning of this project, Save the Children was looking to explore unknowns such as:

  • How have past Save the Children humanitarian projects in two countries (Pakistan and Sudan) evolved and affected changes over the years? And,
  • What does it mean to truly strengthen a health system?

To understand more, we put a team together, with researchers and practitioners from the University of Iowa and from Save the Children, partnering with CORE Group (funded by the Office of U.S. Foreign Disaster Assistance OFDA) in the completion of the studies (read all papers and presentations on the Humanitarian-Development Nexus Collaboration Hub).

Together, given the many uncertainties about the impact of past projects and the meaning of health systems strengthening (HSS), we set out simply to learn. We analyzed the series of recovery projects following two crises: natural disasters and conflict in Pakistan, and the aftermaths of civil war in Sudan. We looked for evidence that any projects strengthened, or weakened, health systems or the ability for an affected community to transition from recovery to long-term development.

The wisdom of the crowd – building on prior research and concepts

We had very few assumptions before beginning our research, but those we had, we held firmly, by looking around us and making sense of what we found. We held, from our own work and others’ research, that the concept of “community-inclusive systems for health” meshed well with both Save the Children’s projects and the ideas that we were articulating with other authors. Those ideas were later published in another paper: “Beyond the Building Blocks: Integrating Community Roles into Health Systems Frameworks to Achieve Health for All”. Other important sources of information to build on included the evolving uncertainties surrounding HSS, as mentioned by authors like Grace Chee, Sara Bennett, and Josefien van Olmen, and ultimately a systematic review of systems strengthening in humanitarian projects, published by the Institute of Tropical Medicine in Antwerp under UHC2030.

With these pieces of information, we moved forward, scanning the EHN and HSS literature with the sole goal of learning.

What we found out

The recovery efforts following a humanitarian crisis are often divided into two types, based on the way financing for such programs is typically available. On one hand, there are short-term recovery efforts, and on the other, long-term development programs. Despite each having different goals, priorities, and funding requirements, both are crucial for repairing and strengthening systems against future crises. In fact, each represents two ends of what we call a ‘humanitarian-development nexus’ – a progression from one stage of recovery to another. Though practitioners and researchers on each end recognize this nexus, financing differences keep the two ends divided.

HSS is a discipline that can help us bridge this division. Its focus is the interrelation of the largest contributors to a population’s health, such as health care delivery, health financing, and policymaking. For HSS to effectively bridge the two ends of the nexus, shorter-term recovery must be designed to pave the way for longer-term development. As part of our analysis, we examined how past Save the Children recovery projects – intentionally or unintentionally – helped or hindered such longer-term development down the road.

Cautious recommendations

Although our analysis was limited in scope, with attention to crises in only two countries, we were still able to uncover some important lessons for future relief projects. Namely: There is a need for strong, shared information and learning systems among all partners in a recovery effort. Crises like these are continually evolving. Funders, governments, community members, and different aid organizations may each have different, and rapidly changing, priorities for recovery, creating a tempestuous sea of overlapping interests. The only way to weather such a storm of complexity is through collaborative learning among all partners – adapting and evolving to the constant change in resources and priorities in the crisis-affected area.  Such collaboration can range from new partner collaborations to shared data agreements and priorities, all things that present their own challenges given common drivers of practice.

We offer our analysis as a modest, first step. Increased urgency for immediate humanitarian relief must not mask the importance of longer-term development, just as the need for local ownership of development cannot eclipse emergency priorities. To connect these two mindsets as a ‘nexus’ of humanitarian-development work, and to help areas affected by crisis more quickly and effectively transition toward stability, we must continue learning from the effects of past relief projects on development. Some additional lessons from our analysis include:

  • It is possible to look ahead while addressing immediate challenges
  • It is possible to course correct
  • Governments will continue to play a central role in what they nurture and what they won’t
  • The ‘ecosystem’ of players within development work has a critical role to play – it’s not just coordination, it’s signaling and providing boundary references
  • Individual emergency projects will struggle to heed our call for more evaluation and learning, but large implementers and donors could play a greater role in identifying and resourcing critical learning questions, whether for evaluation or research

We boldly joined our voices to those of others who have been making recommendations on the ‘transition’ from shorter- to longer-term recovery, but we also took to heart some of our lessons and sought to integrate them in a new approach to designing WITH emergency programs to better identify project contributions for systems strengthening.

Our work continues... Welcome to 2021.

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