Academic Publication

Health systems effects of successive emergency health and nutrition projects: an embedded retrospective case study analysis in Sudan and Pakistan

Authors:
Eric Sarriot
Elijah Olivas
Saraswati Khalsa
Sarah Ashraf
Emily Hejna
Givan Hinds
William T Story
Source:
Oxford Academic
Contributor:
Publication Year:
2021
  • SDG 3 - Good Health and Well-Being

Health systems effects of successive emergency health and nutrition projects: an embedded retrospective case study analysis in Sudan and Pakistan

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.

KEY MESSAGES

  • Increasing attention to a nexus between humanitarian aid and development requires more attention to designing humanitarian programmes for long-term health systems strengthening.

  • Project contributions to systems are negotiated, enabled or constrained, by a complex array of priorities within an ‘eco-system’ of government structures, funders, local leaders, development partners, implementing partners and project leaders.

  • Evaluation and learning are essential to the advancement of systems strengthening. Given constraints on individual emergency projects, the call for more evaluation of systems effects must go to countries, donors and implementing agencies.

  • Even mid-size chronic emergency response projects can make meaningful contributions to health systems strengthening.

 

CITATION:
Eric Sarriot, Elijah Olivas, Saraswati Khalsa, Sarah Ashraf, Emily Hejna, Givan Hinds, William T Story. Health systems effects of successive emergency health and nutrition projects: an embedded retrospective case study analysis in Sudan and Pakistan, Health Policy and Planning, Volume 36, Issue 2, March 2021, Pages 176–186,
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