Priorities and challenges of post-conflict health care

1. Priorities and challenges of post-conflict health care Nick Banatvala Department for International Development

2. Michael J. Waters: “Any serious attempt to launch a successful campaign to achieve the MDGs must pay special attention to conflict-affected countries” UNDP’s HDR 2003 Some 60 countries are in or recently recovering from conflict • A challenge to the MDGs • Post conflict vs. countries emerging from conflict

4. Will and no capacity

5. Cambodia 1989 - 2004 Development 2003- Peace & reconstruction 1998 Post conflict 1989 Conflict

6. Uganda 1986-2004 2004 1994 PRS SWAp/GBS 2004 N Uganda Chronic conflict Civil war 1986

7. Michael J. Waters: • Service delivery for health and education Michael J. Waters: Statistically countries emerging from conflict show a 50% tendency to relapse into conflict in the first 5 years Series of policy and investments to avoid sliding back Investing in countries emerging from conflict • Demobilising, decommissioning, disarming • Rehabilitation: refugees, IDPs, former combatants • Capacity building and infrastructure • Rehabilitation of women and girls • Addressing legitimate grievances • Service delivery for health and education

8. Michael J. Waters: World Development Report 2004 proposes a possible framework for conceptualising pro-poor service delivery that examines the relationships of accountability between the policy maker, the provider and the citizen. It highlights the central role of the state in guaranteeing the provision of pro-poor services and the role of politics in this process A broken service delivery framework Policy maker voice compact Citizen Providers Citizen power

9. Approaches to strengthening service delivery

10. Michael J. Waters: financing community recovery through decentralised structures. Donor coordination key. Strengthen pro-poor policy making • Entry points for building political will • Strengthening the capacity of state policy making functions • Use of non-state mechanisms for policy coordination

11. Michael J. Waters: Working with humanitarian agencies Serious challenges: coordination, harmonisation (with each other) Building provider capacity • Building capacity of state providers • Harnessing non-state providers • Working with humanitarian agencies

12. Reducing barriers to poor people’s access & participation • Strengthening the voices of the poor and vulnerable • Moving resources to community level • Facilitate provider access • Reducing costs of accessing services

13. Michael J. Waters: Using aid approaches and instruments flexibly Highlights the importance of coordination, need to harmonise Michael J. Waters: Questions include: How to rebuild a system that doesn’t simply reproduce and reinforce previous inequalities or replicate dysfunctional alignments and institutions? How to find the right balance between upstream reforms and making sure that services reach people on the ground is key – role of non-state providers is potentially so important Michael J. Waters: Improving the humanitarian/development transition Making trade-offs explicit There are trade offs when in countries are emerging from conflict Short term – humanitarian, service delivery Longer term – facilitate social and political changes that enables an empowering environment Aligning behind country policies is a priority – but not be possible until a peace settlement is fully established into practice………. • Understanding context is crucial • Making trade-offs explicit • Using aid approaches and instruments flexibly

14. Michael J. Waters: Limited evidence as to the impact of how effective these approaches/instruments are in the emerging from conflict environment Using aid instruments

15. Using aid instruments