Quick Links #7: Understanding health provision and communication in inaccessible areas

Below you'll find a brief list of just some of the polio communication resources related to health provision and communication in inaccessible areas from The Communication Initiative for Pakistan and Afghanistan.

Hi Everyone

This Quick Links focuses on the importance of understanding health provision in areas that cannot be accessed.  It can be easy to assume that where there is no access there is no health care.  But demand for health care does not abate during a conflict and when state provision of health care fails or weakens, other actors fill the void.    As communities and individuals continue to seek services the ‘void’ left by deteriorating formal health care infrastructure is filled by an often uncoordinated and usually poorly distributed range of new providers of varied effectiveness.  To work in such environments requires a well-informed understanding of the various actors, the services they provide and which ones can be effective partners in delivering vaccination and other health services.  It also requires a strong understanding of the perceived health priorities of communities living in these areas and respectful engagement with local leaders.  Communities and their leaders need to be engaged to support polio vaccination in relation to the adaptations they have made to the conflict and to their knowledge of local providers and priority health care needs.

Below are three analyses pointing out the importance of understanding these complex and crowded spaces inside conflict-affected areas and how to communicate with the people living in them.

The “empty void” is a crowded space: health service provision at the margins of fragile and conflict affected states

Within the context of international development assistance, much of the analysis on fragile states focuses on the need to develop the state's capacity to provide essential health services within a viable policy framework. The research in this paper shifts that focus, instead exploring the ways in which healthcare provision is configured by multiple actors beyond the reach of the state.  Looking at case studies from Afghanistan, Central African Republic (CAR), Democratic Republic of the Congo (DRC), Haiti, Palestine, and Somalia it illustrates how healthcare provision "is becoming increasingly pluralistic, unplanned, privatized, unregulated and globalised all over the world."

The paper argues that "Donors will need to move closer to the populations which they are supporting. These labour-intensive processes will require intimate local knowledge. Progress will be predicated on stable relationships and the gradual strengthening of local services, preserving what is already functioning, even if inadequately. The social institutions on which development is dependent have to grow at the pace allowed by the context, the actors active in it, and the values permeating the social fabric." Development actors are urged to attend to the direct knowledge of healthcare provision and local context cultivated by private providers, pharmaceutical dealers, and training institutions. This requires identifying and strengthening existing networks that have assumed responsibilities normally associated with the state.

Making sense of apparent chaos: health-care provision in six country case studies

Looking again at Afghanistan, the Central African Republic (CAR), the Democratic Republic of the Congo (DRC), Haiti, Palestine, and Somalia this paper argues that rather than waiting for state-provided health care, the disillusioned inhabitants of conflict-affected areas in these countries have opted for alternative services, mostly privately supplied. This is because autonomous health actors respond to state withdrawal and structural violence - and they do so in assorted ways, from the harmful to the beneficial. In looking at the implications of healthcare provision beyond the reach of the state, the authors suggest that the international development community needs to understand the pluralism, initiative, adaptation, and innovation of these autonomous actors, and to reorient development assistance in order to engage them effectively and in the long term.

Communicating with Communities during Conflict: “Mediated” avenues to inform those in need

The literature on communication and information during and after emergencies, and in conflict and post-conflict environments, is wide. However, as Valentina Baú points out in this commentary, it focuses mostly on crisis-response strategies either from a media and communication studies perspective or from a disaster management perspective. What we need to do now, she suggests, is to start looking at things from the perspective of the broader humanitarian and development effort. Drawing on existing literature, Baú explains how humanitarian organisations and local communities are using the media and other channels to engage in two-way communication exchange. This matters because listening to the voices of those who are affected by crises is crucial in planning a response that is more relevant and tailored to what the real needs of communities are. "This approach, which is increasingly being adopted in humanitarian work, asks us to re-think 'communication' and to expand our view on what we regard as 'media'."

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NEW FOR QUICK LINKS

We now have an archive of all the Quick Links notes and the comments you sent on each.  We will update these as new notes are sent and comments come in.  As many comments were sent directly to me and not shared with the group we have posted them so as to maintain the anonymity of the sender.  If you would like to add further comments or thoughts you can register to the archive forum by going to the CI website and clicking on the ‘register for free’ box in the top right.  Once registered go to the Polio and Immunisation Network where you will find the notes listed and can comment on any of them by opening the note and scrolling down to the comment box.

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For more information see:

CI Polio Network

GPEI Resources

UNICEFs Rhizome C4D site

Cheers

Chris

A note on Quick Links: 

Quick Links is a small experiment from The Communication Initiative that might help those working for polio eradication in Pakistan and Afghanistan identify useful knowledge on issues the programme is facing.  It is designed to be brief and not add too much to anyone's inbox.  Each email focuses on an area of particular importance to the Pakistan and Afghanistan programmes and presents brief descriptions of three resources that may be of interest or use to those of you working in the country.  The mailing list, by design, is quite small though anyone who's interested can send a request to cmorry@comminit.com and they'll be added to the list.  We also welcome suggestions and requests for specific topics to be covered and/or resources to be identified.