In a new research paper aiming to better understand the resilience of health capacities in crisis situations, experts from the Faculty of Health Sciences (FHS) at the American University of Beirut (AUB), the Institute for Global Health and Development at Queen Margaret University (QMU), and the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) conducted jointly a research studying the resilience of health systems in counries hosting Palestinian refugees fleeing the Syrian conflict.
The research focused on three main themes:
1- Theme 1: Absorption and immediate crisis response depends on the extent of both soft and hard system resources
Under this theme, researchers explored key issues such as Organizational mission and the service delivery, the effectiveness of the logistical responsiveness in mitigating the impact of the crisis, funds mobilization, and health systems reforms.
2- Theme 2: Resource exhaustion prompts adaptation: UNRWA services expand collaboratively
The paper also addressed the impact of the crisis on UNRWA resources, the limitations of the policies in place regarding access to healthcare, and the actions taken in this regard to sustain medicine supply and enhance service delivery capacity.
3- Theme 3: Re-shaping the health system and wider host-country context: transformation of UNRWA's role and service delivery.
As the conflict in the region showed no sign of abating and as displaced Palestinian refugees coming from Syria started to settle in host countries, UNRWA systems had become the principal custodians. In order to deal with this new situation, UNRWA introduced new systems to improve registration processes, while it bolstered advocacy efforts to establish effective partnerships with various stakeholders throughout the region.
The results found that the UNRWA systems in Lebanon and Jordan were broadly resilient, deploying diverse strategies to address health challenges and friction between host and refugee populations.
On the importance of the adaptation, absorption, and transformation of local health systems Dr. Mohamad Alameddine from FHS, AUB commented “At time of uncertainty and with the complexities and challenges characterizing fragile settings in our region and elsewhere, it is pivotal to develop a better understanding of the elements that could support the resilience of health systems. This study is novel in its methodology and analytic approach. The pro-capacities analysis supports the identification of absorptive, adaptive and transformative capacities that would support resilience in the complex and poorly resourced setting of UNRWA." He added "the authors hope the study would help support policy recommendations that would enhance resilience in health systems facing adversity while catalysing further investigation on this important topic.”
In his turn, Dr. Akihiro Seita, director of the Health Department of UNRWA Office in Jordan, considered the study as "another proof of the commitment and hard work of UNRWA health staff. Despite all difficulties, UNRWA systems and staff continue to explore best possible & optimal way to sustain its services. I truly appreciate this joint study to unveil UNRWA’s commitment with analysis."
Professor Sophie Witter from the Institute for Global Health and Development at QMU stated "In our changing and unstable world, resilience is key to survival and thriving. In this article, we examine what this concept means for health services and how one organisation, UNWRA, working in Jordan and Lebanon exhibited this quality. Using an exciting participatory method, we analyse some key capacities underlying resilience and what drives them. The findings will have relevance for a wide range of other institutions and settings."
Researchers completed 62 semi-structured interviews (30 in Lebanon in November–December 2016, and 32 in Jordan in January 2017) with professionals at primary care, area, and country management levels. Participants reflected on changes in population health status and health service delivery during the Syrian crisis, notably with respect to the influx of refugees from Syria. Interviews were analyzed through inductive thematic analysis and used to critically interrogate health systems resilience against a pro-capacities framework.
Resilience is increasingly recognized as a key process mitigating the impact of shocks and stressors on functioning. The literature on individual and community resilience is being extended to address characteristics of resilient service delivery systems in contexts of adversity. The validity and utility of a capacity-oriented resilience framework (including absorption, adaptation and transformation) is examined in this paper with respect to the functioning of UNRWA health systems in Lebanon and Jordan in the context of the Syrian crisis.
While the study adds to the limited literature on health system and organizational resilience and indicates that capacity-oriented framings of resilience are valuable in extracting generalizable lessons for health systems facing adversity.
To read the full study, please click HERE.