The Humanitarian Health Evidence Review

METHODOLOGIES AND QUALITY OF EVIDENCE:

• There has been increasing interest in health systems research in humanitarian crises. There are nevertheless many questions about how to conduct health research in insecure and unpredictable settings. As a result, the quality of studies is questionable and has often been rated as low. There is a pressing need for introducing innovative and robust methods to study health systems in humanitarian crises.
• One constraint identified by the key informants is the lack of reliable health information systems in most developing countries before the crisis starts. Researchers have to conduct research where baseline data is often inconsistent or missing.

DELIVERY AND INTEGRATION OF INTERVENTIONS INTO LOCAL HEALTH SYSTEMS:

• Humanitarian interventions are often implemented in parallel to the local health systems, which have most often 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 system. 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, often accompanied with free healthcare, may create unexpected effects on local health services. These aspects have nevertheless not been explored by researchers.
• A third aspect highlighted by respondents is the importance of measuring the effectiveness of different models of delivery. 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 a different model of delivery.

CONTINUITY OF CARE:

• The issue of integration is also related to the continuity of care, which, as many key informants explained, is a necessity in a context where chronic diseases and non communicable diseases (NCDs) are increasingly important. Studies should focus on the assessment of health systems capacities to deliver quality services after the departure of humanitarian actors.

THE RESILIENCE OF HEALTH SYSTEMS:

• Research is needed to measure and predict the capacity of health systems to adapt to humanitarian crises. This notion of resilience is related to measurement of preparedness for crises. There is limited evidence on the impact of preparedness activities on the capacity of health systems to absorb or adjust to crises.