Bridging humanitarian, development, and security concerns to advance health for all
The COVID-19 pandemic has demonstrated how a global health threat can quickly undermine development gains and exact a heavy toll on the world’s most vulnerable people — including the urban poor in low-income settlements, displaced populations, and victims of weak governance, disasters, and armed conflict — who have borne the brunt of efforts to contain the COVID-19 pandemic.
For decades, these marginalized groups have been the focus of global humanitarian and development support and efforts to foster peace and security. However, these three sectors have often worked in silos. Now they require greater collaboration and more innovation to support transitions out of crisis, to have meaningful, lasting impact on health and well-being, and to promote gender equality.
The World Bank estimates that two-thirds of the world’s poor will be living in settings characterized by fragility, conflict, and violence by 2030. In recent years, the number of displaced people has increased, and low- and middle-income countries that already faced their own domestic challenges are now host to 84% of the world’s 25.4 million refugees, according to the United Nations Refugee Agency. International platforms like the Global Compact on Refugees and the Global Refugee Forum have referenced the need for humanitarian assistance, development aid, and peace and security actors to work together. The call for a convergence of sectors in this “triple nexus” has thus far had limited influence on policy and programming, but research can provide key insights on how the sectors can improve collaboration and make decisions based on evidence.
Breaking down silos to improve lives
A five-year partnership with the Ministry of Public Health in Afghanistan, Global Affairs Canada, and the French Development Agency, led by Aga Khan Foundation Canada (AKFC), is an example of this collaborative programming. Despite working in insecure environments, the Health Action Plan for Afghanistan developed and maintained relationships with a variety of actors across sectors to improve health, nutrition, food security, access to water and sanitation, gender equality, and women’s empowerment. The program engaged with local communities and women’s organizations in 37 districts to ensure that violence and insecurity did not hamper gains in women’s and children’s health.
Another cross-sector example can be found in Torit, South Sudan, where a research team worked with existing women’s savings groups involved in peacebuilding activities to engage communities in decision-making in healthcare. Part of the seven-year Innovating for Maternal and Child Health in Africa initiative, and in partnership with the South Sudan Ministry of Health, the project increased community awareness of health issues and mobilized women to resolve problems and improve the responsiveness of health services. Through their engagement with the research project, the women realized that addressing their health needs was critical and successfully advocated for change, such as hiring additional midwives for healthcare facilities.
Six priority areas for sustainable collaboration
IDRC and AKFC co-hosted a symposium on global health and gender in the triple nexus to share lessons and encourage dialogue about how the humanitarian, development, and peace and security sectors can work together. The following priorities were identified to promote more effective programming.
Reconcile short- and long-term action. Humanitarian responses that circumvent community systems and formal structures weakens them. For example, past responses to health crises have undermined the role of community health workers, health system structures, and longer-term efforts to build capacity. Similarly, development approaches — including strengthening health systems — should not overlook preparedness aspects that are vital to respond to crises and for early recovery. AKFC’s years of investment to strengthen local institutions in northern Mozambique equipped community groups to act as first responders when cyclone Idai hit in 2019. Relief, recovery, and resilience efforts must work hand in hand under any conditions.
Improve integration between peace and security, humanitarian, and development efforts. Peace and stabilization actors can provide historical and political context that are crucial to designing and implementing sound humanitarian and development interventions. Likewise, humanitarian and development actors can build foundational grounds for rebuilding peace and stability if they are implemented in a coordinated manner. For example, recent Global Affairs Canada evaluations show that landmine removal organizations in Colombia succeeded when they coordinated their efforts with development actors to enable the safe entry of support projects for agricultural cooperatives.
Focus on gender equality in all sectors of the nexus. Promoting gender equality must be a specific focus for humanitarian, development, and peacemaking interventions to ensure they do not exacerbate gender inequalities. Insights from IMCHA-supported research in Kenya and Uganda point to the specific gender-based constraints that female health workers face due to safety concerns, the heavy burden of home and community work, and limitations on access to capital and transport, which are compounded in fragile contexts.
Develop context-sensitive strategies and guidelines. Global strategies and operational guidelines are often insufficient or context blind. One example is using humanitarian sector guidance to direct support for displaced populations who remain in host countries for extended periods. Developing context-sensitive guidelines for development settings, conflict situations, and humanitarian contexts can improve effectiveness. IDRC supported a global effort (reported in a special journal issue of Conflict and Health) to develop maternal and child health guidelines in conflict settings.
Enhance collaboration through research across the three sectors. Research is critical for identifying organizational barriers to collaboration, designing evidence-based interventions that span the nexus, and generating integrated, disaggregated data to highlight impacts on vulnerable groups, including women and girls.
Involve communities and local civil society in decision-making across the nexus. Transferring programs and solutions from one context to another often leads to suboptimal results. Encouraging the active participation of communities and non-governmental organizations that are representative of all members of society can improve results.
The benefits of working together across sectors outweigh the challenges. With the COVID-19 pandemic, growing climate risks, and continuing threats of conflict, we need to align organizational mandates to create more coherent programming, enhance funding flows, and improve communication and knowledge sharing across humanitarian, development, and peace and security sectors.