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Conflict and health
- A Griekspoor (16 August 2000)
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A Griekspoor
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Editor - Banatvala and Zwi are indeed right to advocate for evidence base to improve humanitarian responses. We can only agree that interventions by the aid community should be informed by the best public health knowledge available and that collaboration is needed. The paper however, seems to suggest that not much is done in this field so we thought it appropriate to draw attention to some initiatives. We also take the opportunity to put some caveats to the principles of evidence based interventions to avoid unrealistic expectations or inappropriate use. Although the authors refer to the Sphere project as one example of a collaborative initiative, we would further like to mention the ODI based 'Active Learning Network on Accountability and Performance' in which UN agencies, donors, the Red Cross Movement, NGOs and academics participate. Another initiative in which most humanitarian actors and academics are represented is the WHO/EHA-based 'Advisory Group on Research in Emergencies'. WHO collaborative debate on its role in emergencies started in 1997. The latest consultation dealt with "Planning Ahead for the Health Impact of Complex Emergencies" in December 1999. Concerning cost- effectiveness, WHO and FICOSSER recently organised a meeting on using health economics in decision making in emergencies. The meeting looked at more concrete ideas to put this in practice. Nevertheless, expectations in this direction should be tempered. Humanitarian needs are so high and available resources so restricted, that margins through greater cost- effectiveness are in fact small. Furthermore, life-saving activities have favourable cost-effectiveness ratios even when costs are relatively high. There are a wide variety of processes supporting humanitarian action with knowledge. Nevertheless, the quest for 'evidence' should be interpreted with some caution. Research and evaluation findings are mainly applicable to situations similar to those from which they are derived. Evidence is needed to formulate standards for good practice, but standards are only valid for predictable problems in predictable contexts. As the authors acknowledge in their paper, predictability is a scarce commodity in complex emergencies. Certain situations require innovative and tailored, rather than standardised responses, which does not necessarily mean ad- hoc. On top of this, most interventions have more than one intended effect. One-dimensional thinking may compromise humanitarian principles and practice. Evidence of good practice cannot be rigidly transferred. It should be integrated with local, contextual intelligence to take informed and appropriate decisions. This may imply deliberate compromises on quality in some areas, and higher standards of performance in others. A. Griekspoor (corresponding author)
A. Loretti
1. Banatvala N., Zwi A.B. Conflict and Health. Public health and humanitarian interventions: developing the evidence base. BMJ 2000; 321:101-5. (8 July) 2. http://www.odi.org.uk/alnap/ accessed 10-8-2000 3. http://www.who.int/eha/ Reports AGRE meetings, accessed 10-8 2000 4. Proceedings from "Consultation on Planning Ahead for the Health Impact of Complex Emergencies" WHO-Geneva, December 13-14 , 1999 . 5. Use of health economics for decision making in complex emergencies. Report of the workshop held in Paris, December 16-18, 1999. WHO and FICOSSER, June 2000 |
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