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Healthcare in Conflict: Implementing Reform during Reconstruction



Social uprising is the new normal. This is evident to anyone with access to a television within the past few years. From Occupy Wall Street to the wonders of the Arab Spring, people all over the world are demanding changes to a status quo where a small minority seemingly reaps all benefits the world has to offer while leaving the majority to fight for remaining crumbs. In these movements, the central ideology being fought for is the idea of justice. The faces of these unjust societies range from authoritarian regimes to unchecked capitalist powerhouses. As the process of reconstruction takes place (whether it be physical or mental), a common demand is the reform of health care systems. This is not surprising considering the intertwined nature of the right to health with the mechanisms through which they are disseminated.

A common hallmark of pre-conflict nations’ is an inequitable distribution of health care goods and services. In the case of the Arab Spring, democratization of governments creates an interesting opportunity to renovate their health care systems from the ground up. “The framing of social issues into a rights-based framework allows the world to see the marginalized as protagonists rather than subjects of oppressive systems. That gives them the agency to make social change, as opposed to when they were labeled as passive recipients of generosity” (2). New demands call for new ways of ensuring people’s right to health.

So how is this done? For starters, certain factors have to be taken into consideration. They include:

  1. Health status of the nation
  2. Acute and future health care needs of the population
  3. State of health care infrastructure post conflict
  4. How was health care delivered prior to conflict
  5. Availability and capabilities of the health workforce

Once you know what you are actually working with, a plan can be set in motion. Health care redevelopment is another stage driven process with many overlapping actions which includes:

  1. Development of a national policy framework,
  2.  Reliable financial plan
  3. Equitable service allocation plan
  4. Institutional and human capacity building
  5. Infrastructure redevelopment
  6. Community development and engagement with civil society

 As we continue to witness countries make these transitions, special attention will be paid to the manner in which health reform is implemented. The reprogramming of people’s expectations requires incoming governments to take heed if peace is what is sought. In this respect, it could be stated that the success of reform implementation is an indicator of long term stability since it is accepted that an “…early commitment to reform is one of the most effective tools new governments can use to prove their legitimacy” (2). 






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Who’s Down with PPP?

Public-Private Partnerships. It’s the international development world’s catch phrase of all catch phrases. Its clever name gives the impression that the best of both worlds will be had…I mean, why not? Implementing the hard earned expertise of the private sector with the empirical knowledge of local governments is sure to have positive and lasting impacts on target areas of interests. I’ll be the first to admit that I was absolutely down for this deal at first glance. But as with all things in life, there’s a catch…a lot of them actually.

Further analysis of the basic framework of public private partnerships, leads one to the realization that this is not as simple as it looks. For starters, the world has not yet outlined international standards for the handling of said partnerships although a great deal of PPPs have bilateral relationships. Drawing from the US based Centre for Public Private Partnerships’ principles of successful PPPs – (1) political leadership, (2) public sector involvement, (3) a well thought out plan, (4) a dedicated income stream and (5) communication with stakeholders – one cannot help but notice the interesting conundrum that is inherent in the very success of these programs…it appears as if it would take strong and functioning governmental leadership in order to have a decent shot at making these programs work. What we see in the real world is the very reason why many developing countries are in need of these sorts of relationships to begin with is precisely due to the fact that their governments do not exhibit these traits. This is problematic when you realize that a central tenet of these symbiotic arrangements is that both entities should be able to benefit from the partnership while maintaining equal standing with respect to power….so what happens when this doesn’t happen? How can a developing nation truly stand tall and defend its national interests, particularly as it pertains to health PPPs, in the face of the “first world” clout. This absolutely should not be taken lightly considering the implications PPPs could potentially have on the world’s most vulnerable citizens.

As it turns out, there is somewhat of a tiny, dim light at the end of the tunnel. Plans to develop current international standards and recommendations on PPPs are being discussed as we speak by the United Nations Economic Commission for Europe (UNECE), a decent starting point in this no man’s land. These plans are supposed to address the lack of capacity of the governments of developing countries and provide clear models to base their projects and programs. This is by no means the cure to the intrinsic problems found in PPPs. The hope is that they will at least serve as a sort of leveraging tool that developing countries can use moving forward to protect their interests and ultimately better serve the needs of those that need it the most.


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