What differences are required to address rebuilding health systems in post conflict situations?

What sort of differences or allowances do you believe need to be communicated through a program design for rebuilding health systems in particular in post conflict situations, like East Timor or Solomon Islands?

One of the first things to consider is how to build trust in the government systems and to re-build communities. A lot of primary health care work needs active community support, mobilisation and participation, but the experiences in Cambodia found that natural communities had been completely torn apart – even family groups were scattered – and so there was not a fabric of social cohesion upon which to start to build.

Secondly, the transitioning of the approaches used in conflict/short term post conflict programming and health services delivery needs to be carefully planned and managed. (Some of the problems that are faced in Cambodia - with a large number of NGOs which helped rebuild a system but now are often working in an uncoordinated fashion, some paying limited heed to national goals, priorities and standards, often unnecessary and ineffective overlap and difficult for emerging national and provincial health department to manage the harmonisation and coordination functions).

Thirdly, ensuring that national leadership and ownership of the approach (programme design) is supported. Fourthly, ensure that there is a focus on service delivery of the essential health packages that have a strong evidence base and are cost effective – do not try to build a perfect health system or move into major areas of health sector reform before starting with the basics. Engaging with health staff already in the country and encouraging those who have left to return and be retained will be important as may be some supplementary short term assistance to Fast track trained primary health care cadre to get the basics back up and running. (Remember the health staff have been affected by the conflict like their community – and this needs to be addressed – meeting their and their families basic living needs will be important). And although investment in buildings is often seen as something no longer encouraged in development assistance, there may be a need to situate strategical primary health care facilities and first referral level facilities according to a well thought out accessibility model that is community focussed.