Journal article
Health systems effects of successive emergency health and nutrition projects: an embedded retrospective case study analysis in Sudan and Pakistan
Health policy and planning, Vol.36(2), pp.176-186
03/26/2021
DOI: 10.1093/heapol/czaa096
PMID: 33462605
Abstract
Abstract Despite increasing attention to the concept of a humanitarian-development nexus in recent years, limited research is available to improve health systems strengthening practice within humanitarian programmes. We used an exploratory, systematic, embedded, multiple case study design to discern systems effects of successive Save the Children chronic emergency health and nutrition projects implemented in Sudan and Pakistan between 2011 and 2018. We used textual analysis to code 63 documents focused on eight themes using NVivo 11.0. This was supplemented by six key informant interviews. Findings offer a complex and mixed picture, with contributions to systems strengthening in community systems, their linkages to health management structures, and human resources for health. Projects with primary mandates for urgent service delivery progressively found systems strengthening opportunities, through a combination of tacit choices and explicit objectives. In both countries, some ‘parallel systems’ were set in place initially, with immediate gains (e.g. quality of services) only occasionally accompanied by enhanced systems capacity to sustain them. Cycles of implementation, however, achieved financial transition of ‘macro-costs’ to the government (e.g. facilities in Sudan, staff in Pakistan) through indirect pathways and the influence of pluralistic governmental structures themselves. Opportunities were taken, or missed, based on dynamic relationships within the government-development partners eco-system. Transition steps also came with unintended effects and drops in intensity. Both project contributions to systems strengthening and our own study were limited by substantial gaps in evaluation and documentation processes. We provide cautious recommendations based on the literature and our two case studies. Even mid-size chronic emergency projects can and should make meaningful and explicit contributions to systems strengthening. This contribution will, however, depend on the development eco-system context, and development of better collective intelligence (coordination, evaluation and learning, benchmarking, accountability) to improve individual projects’ adaptive management efforts to improve fit with evolving national systems.
Details
- Title: Subtitle
- Health systems effects of successive emergency health and nutrition projects: an embedded retrospective case study analysis in Sudan and Pakistan
- Creators
- Eric Sarriot - Save the Children, Department of Global Health, 899 North Capitol St NE #900, Washington, DC 20002, USAElijah Olivas - Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Dr, Iowa City, IA 52242, USASaraswati Khalsa - Save the Children, Department of Global Health, 899 North Capitol St NE #900, Washington, DC 20002, USASarah Ashraf - Save the Children, Department of Global Health, 899 North Capitol St NE #900, Washington, DC 20002, USAEmily Hejna - Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Dr, Iowa City, IA 52242, USAGivan Hinds - Independent Consultant, 4553 Lake Chapin Shores, Berrien Springs, MI 49103, USAWilliam T Story - Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Dr, Iowa City, IA 52242, USA
- Resource Type
- Journal article
- Publication Details
- Health policy and planning, Vol.36(2), pp.176-186
- DOI
- 10.1093/heapol/czaa096
- PMID
- 33462605
- NLM abbreviation
- Health Policy Plan
- ISSN
- 0268-1080
- eISSN
- 1460-2237
- Grant note
- name: Save the Children USA’s Department for Global Health; name: CORE Group Humanitarian-Development Task Force through the United States Agency for International Development; name: Office of U.S. Foreign Disaster Assistance, award: 720FDA18GR000107
- Language
- English
- Date published
- 03/26/2021
- Academic Unit
- Community and Behavioral Health
- Record Identifier
- 9984214795502771
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