Addressing fragility through community-based health programmes: insights from two qualitative case study evaluations in South Sudan and Haiti View Full Text


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Article Info

DATE

2019-12

AUTHORS

Séverine Erismann, Sibel Gürler, Verena Wieland, Helen Prytherch, Nino Künzli, Jürg Utzinger, Bernadette Peterhans

ABSTRACT

BACKGROUND: Fragility can have a negative effect on health systems and people's health, and poses considerable challenges for actors implementing health programmes. However, how such programmes, in turn, affect the overall fragility of a context is rarely considered. The Swiss Red Cross has been active in South Sudan and Haiti since 2008 and 2011, respectively, and commissioned a scoping study to shed new light on this issue within the frame of a learning process launched in 2015. METHODS: The study consisted of a document review, qualitative field research undertaken between June and August 2015 in South Sudan and Haiti, and two data triangulation/validation workshops. Semi-structured key informant interviews and focus group discussions included 49 purposively sampled participants who helped build a deeper understanding of what constitutes and drives fragility in the respective countries. Moreover, interviews and focus group discussions served to grasp positive and negative effects that the Swiss Red Cross's activities may have had on the overall state of fragility in the given contexts. RESULTS: Qualitative data from the two case studies suggest that the community-based health programmes implemented in South Sudan and Haiti may have influenced certain drivers of fragility. While impacts cannot be measured or quantified in the absence of a baseline (the projects were not originally designed to mitigate overall fragility), the study nevertheless reveals entry points for designing programmes that are responsive to the overall fragility context and contain more specific elements for navigating a more sustainable pathway out of fragility. There are, however, multiple challenges, especially considering the complexity of fragile and conflict-affected contexts where a multitude of local and international actors with different goals and strategies interfere in a rapidly changing setting. CONCLUSIONS: Health programmes may not only reach their health objectives but might potentially also contribute towards mitigating overall fragility. However, considerable hurdles remain for aid agencies, especially where scope for action is limited for a single actor and where engagement with state structures is difficult. Thus, cooperation and exchange with other aid and development actors across the spectrum has to be strengthened to increase the coherence of aid policies and interventions of actors both within and across the different aid communities. More... »

PAGES

20

References to SciGraph publications

  • 2013-12. Aid alignment: a longer term lens on trends in development assistance for health in Uganda in GLOBALIZATION AND HEALTH
  • 2017-12. Health systems research in fragile and conflict affected states: a qualitative study of associated challenges in HEALTH RESEARCH POLICY AND SYSTEMS
  • 2015-03. Social cohesion and resilience across communities that have experienced a disaster in NATURAL HAZARDS
  • 2012-03. Coordination in food security crises: a stakeholder analysis of the challenges facing the global food security cluster in FOOD SECURITY
  • 2015-12. Health in the service of state-building in fragile and conflict affected contexts: an additional challenge in the medical-humanitarian environment in CONFLICT AND HEALTH
  • 2009-12. Identity in Fragile States: Social cohesion and state building in DEVELOPMENT
  • 2012-12. Development cooperation for health: reviewing a dynamic concept in a complex global aid environment in GLOBALIZATION AND HEALTH
  • 2015-12. State-building and human resources for health in fragile and conflict-affected states: exploring the linkages in HUMAN RESOURCES FOR HEALTH
  • 2016-12. Health systems research in fragile and conflict-affected states: a research agenda-setting exercise in HEALTH RESEARCH POLICY AND SYSTEMS
  • 2011-12. The UN OCHA cluster approach: gaps between theory and practice in JOURNAL OF PUBLIC HEALTH
  • 2015-12. Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework in IMPLEMENTATION SCIENCE
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    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30764847


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    36 schema:description BACKGROUND: Fragility can have a negative effect on health systems and people's health, and poses considerable challenges for actors implementing health programmes. However, how such programmes, in turn, affect the overall fragility of a context is rarely considered. The Swiss Red Cross has been active in South Sudan and Haiti since 2008 and 2011, respectively, and commissioned a scoping study to shed new light on this issue within the frame of a learning process launched in 2015. METHODS: The study consisted of a document review, qualitative field research undertaken between June and August 2015 in South Sudan and Haiti, and two data triangulation/validation workshops. Semi-structured key informant interviews and focus group discussions included 49 purposively sampled participants who helped build a deeper understanding of what constitutes and drives fragility in the respective countries. Moreover, interviews and focus group discussions served to grasp positive and negative effects that the Swiss Red Cross's activities may have had on the overall state of fragility in the given contexts. RESULTS: Qualitative data from the two case studies suggest that the community-based health programmes implemented in South Sudan and Haiti may have influenced certain drivers of fragility. While impacts cannot be measured or quantified in the absence of a baseline (the projects were not originally designed to mitigate overall fragility), the study nevertheless reveals entry points for designing programmes that are responsive to the overall fragility context and contain more specific elements for navigating a more sustainable pathway out of fragility. There are, however, multiple challenges, especially considering the complexity of fragile and conflict-affected contexts where a multitude of local and international actors with different goals and strategies interfere in a rapidly changing setting. CONCLUSIONS: Health programmes may not only reach their health objectives but might potentially also contribute towards mitigating overall fragility. However, considerable hurdles remain for aid agencies, especially where scope for action is limited for a single actor and where engagement with state structures is difficult. Thus, cooperation and exchange with other aid and development actors across the spectrum has to be strengthened to increase the coherence of aid policies and interventions of actors both within and across the different aid communities.
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