In partnership with NATO’s Joint Analysis and Lessons Learned Centre, the Department’s Program on Global Public Policy and Social Change recently released a case study from Haiti: a working paper “toward creating a comprehensive response to health system strengthening in crisis-affected fragile states.” This report is the first in a series of case studies under way to inform optimal coordinated international responses to countries in crisis. The overarching project is to examine contributions of the security community to humanitarian and development projects. 

Vanessa B. Kerry, MD, Director of the Program on Global Public Policy and Social Change, and Margaret Bourdeaux, MD, Instructor in Medicine at Brigham and Women’s Hospital, conducted the study in collaboration with representatives from the North Atlantic Treaty Organization and the Harvard Humanitarian Initiative. The study involved literature review, background and field-based interviews, and analysis during an approximately 18-month period. According to the executive summary, “Haiti met all three criteria established for case study selection: it is a fragile state whose health system was threatened by a major earthquake followed by a major cholera outbreak; there was a global crisis response directed towards health system strengthening; and a multinational military force with a peace-keeping/peace-building or stabilization mandate was present.” The report develops four key themes: “the impact of the earthquake and the subsequent cholera epidemic on Haiti’s health system; security community participation in health system recovery and reconstruction; coordination mechanisms that facilitated or directed the security community’s involvement; and the information generating and sharing mechanisms that allowed the security community to best participate in health system strengthening.”

Here is the full Haiti Case Study. We also excerpt the “takeaways”:

“As this report represents the first in a series of case studies, no specific recommendations are made. But three takeaways have been identified for consideration by global crisis responders to develop future frameworks for strengthening state health systems:

• In an overwhelming, chaotic, disaster situation the security community might be an appropriate contributor to strengthen some elements of the health system: securing the supply chain; contributing to the health service delivery in providing surge secondary and tertiary care to assist health organizations regain their pre-crisis levels of functioning; supporting local and international leadership by providing security to health stakeholders.
• Coordination among the key actors from the humanitarian and security community in the health sector is essential and requires long-term relationship to ensure that: there is mutual understanding among the security and humanitarian communities such that coordination mechanisms are in place prior to crisis responses; interoperability exists between the different coordination mechanisms; threats to health systems are detected and responded to quickly; Host Nation governance over the responders is clarified and supported by all means.
• An efficient and pragmatic way for coordination among the humanitarian and security communities is to create, and for all actors to contribute to, a commonly shared health information picture which is essential for timely service delivery and early detection of health threats. New technologies have the potential to enhance a holistic picture to disaster response.”