The Humanitarian Health Evidence Review

METHODOLOGIES AND QUALITY OF EVIDENCE:

• Health service delivery is a cross-cutting issue common to every health topic. Most research gaps in public health in humanitarian crises concern the mode of delivery of health interventions. However, the number of studies in this field remains very limited.
• There has been increasing interest in research on health service delivery in humanitarian crises during the last decade. However, the quality of many studies is questionable. There is a pressing need for introducing innovative and robust methods to study health service delivery in humanitarian crises.
• There needs to be better use of mathematical models in assessing the (cost) effectiveness of different models of delivery.

MODEL OF DELIVERY AND INTEGRATION OF INTERVENTIONS INTO LOCAL HEALTH SERVICES:

• Humanitarian interventions are often in parallel to the local health services which have usually been weakened by the crisis. Many respondents mentioned the necessity of collaborating with local health services to ensure the continuity of care after the end of the humanitarian crisis. There is, however, little evidence on the most effective way of integrating humanitarian interventions into the local health services. There are additional research questions related to: which interventions should be integrated? Which ones should be vertically delivered?
• The objective of universal coverage during humanitarian crises is often accompanied with free healthcare but may create unexpected effects (positive and negative) on local health services and has issues for sustainability and equity of services. These aspects have nevertheless not been explored sufficiently by researchers.
• The importance of measuring the effectiveness of different models of delivery was highlighted. Comparisons should be made between facility-based and community-based interventions as well as the delivery of comprehensive packages of interventions compared with single interventions. This field of investigation is broad as every health topic may have different models of delivery.
• Packages of care are commonly promoted but need more research evidence-base for the content of packages, costs of the package, and health benefits of packages. There is also a lack of evidence on the minimum package that could be implemented in very acute settings and what the tradeoffs may be.

CONTINUITY OF CARE:

• The issue of integration is also related to the continuity of care which is a necessity in a context where chronic diseases and NCDs are increasingly important. Studies should focus on examining health facility capacities to deliver and financially sustain quality services after the departure of humanitarian actors.
• There is a need for much more evidence on how to develop longer-term strategies for delivering health care (including for the health system more broadly) to move beyond the short-term approaches common to humanitarian settings.