Bouncing Back: Resiliency and Community Health Systems – Liberia, Nepal and Pakistan

Developing countries often face the unexpected: disease outbreaks, natural disasters, and political unrest. To sustain advances in their health systems while safeguarding communities, health staff and organizations need strategies that promote system resilience—the capacity to anticipate and respond to crises; maintain core functions when shocks strike; and reorganize when extreme conditions or circumstances arise.

At the recent Cracking the Nut Health Conference in Washington, DC, JSI presenters described how to scale innovation which led to improved community health resilience following emergencies in three countries: Liberia, Nepal, and Pakistan.

Yvonne Kodl described the Ebola Recovery and Resilience Project, which used mobile technology, including GPS mapping and time stamping, to monitor and improve food security in Liberia’s Bong and Nimba counties. The project’s strong links to communities and county health teams are closely associated with increased uptake of basic services and improved communication and management skills. Over 100,000 vouchers were disbursed to more than 5,000 households.

Leela Khanal shared health resilience approaches used after the 2015 Nepal earthquake. Motivation and mobilization of female community health volunteers (critical health system actors at grassroots level) on postnatal care and emergency nutrition and counseling, distributing toolkits with commodities and emergency messages, and mobilizing teachers and youth groups for community projects helped to rebuild affected communities.

Nancy Brady spoke about improving routine immunization through an innovative health systems strengthening approach in Pakistan’s Sindh province, where child vaccination rates are dangerously low. JSI’s team identified the numerous gaps and challenges in EPI service delivery and organized focal community immunization champions; utilized SMS technology to improve reporting, transparency and vaccinator accountability; provided training for district health management teams; and increased awareness of EPI in the community. These interventions led to a doubling of EPI registration within two years, and increased the percentage of children and pregnant women receiving polio, pneumococcus, and measles vaccines.

Emergencies can disrupt infrastructure, distract governments, and devastate communities. Through support for government accountability, behavior change at all levels, and strong community structures, resilience can speed the transition from emergency to development.

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