Are Emergency Responses Undermining the Health Systems?

December 13, 2012

There is often tension between a non-governmental organisation’s (NGO) humanitarian focus and long-term capacity building. So the question is: can we work within a country’s current health system during an emergency rather than running parallel programs that can undermine fragile health systems?

The Scaling Up Nutrition in Fragile Health and Community Systems learning seminar was presented by Concern Worldwide in collaboration with the Irish Forum for Global Health (IFGH) and the Development Studies Association (DSA) of Ireland on December 10, 2012. The seminar focused on approaches to strengthening health systems in ‘fragile’ contexts – where the burden of child and maternal mortality, morbidity and undernutrition are generally highest.

Dr. David Weakliam opened the day by giving some background into why health systems are important and that there should be an emphasis on preparing systems for disasters. He stated that although interventions deliver the outcomes, we need to work within the system to provide effective and efficient interventions. In many contexts this will involve strengthening the health and community systems at facility, district and national levels. However, traditional approaches to system strengthening often overlook the need to plan for and respond to emergencies.

It is with this in mind that the Community-based Management for Acute Malnutrition (CMAM) Surge Capacity Model, which will be piloted in 2013, was presented. The objective is to strengthen the capacity of government health systems to effectively manage increased caseloads of severe acute malnutrition during predictable emergencies without undermining on-going systems strengthening efforts.

CMAM was developed to manage acute malnutrition in emergencies and has been proven to be effective by optimising coverage while achieving treatment outcomes that meet or exceed international standards.[1] According to estimates, more than 51 million children under five were affected by acute malnutrition in 2011.[2] Spikes in acute malnutrition often occur after food and health emergencies; however, these spikes also occur seasonally in some countries without an emergency being declared.

For the Surge Capacity Model to work there needs to be at least a partially functioning health system already in place. As Regine Kopplow, a Nutrition Adviser at Concern Worldwide, pointed out we “cannot scale up something in an emergency which is not there in a non-emergency situation”.  The type of support that would be provided during an emergency would be agreed upon with prior to an emergency and is only meant to fill the gap due to a deteriorating situation while continuing with health system strengthening.

The CMAM surge capacity model would be used in areas that experience seasonal spikes of malnutrition and where there is a likelihood of disasters. It involves having health facilities to define their own capacity and the threshold at which they feel their resources are not enough to properly deal with the caseload. If this threshold is met it should trigger a response at the district level to increase the support at that health facility. It is a matter of changing the type of support according to the needs of each health facility as defined by the health facility itself.

In closing, Connell Foley from Concern Worldwide noted that the key was to “make the systems as simple as possible.” In order to prepare for emergencies while continuing to strengthen the health system, we need to keep things to a minimum. It is a balance of creating resilience alongside of capacity building while not overburdening the health system.

Rinette Reimer
Key Correspondent

[1]Wilford, R., Golden, K. and Walker, D.G. (2011) ‘Cost-effectiveness of community-based management of acute malnutrition in Malawi’, Health Policy and Planning (Volume 27, Issue 8, Pages 1-11)

[2]UNICEF, WHO and WB (2012), ‘UNICEF, WHO and WB – Joint Child Malnutrition Estimates’,  UNICEF: New York, USA


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