Community Management: Sustaining Local Health Services During the Transition to Recovery

Since the early 1990s, international aid organizations have been drawn progressively into the provision of health and other essential social services in conflict-affected countries. As time passes short-term projects give way to rehabilitation assistance whose primary aim is to help restore local services and pave the way for recovery. Rehabilitation theory suggests that during this transition, humanitarian agencies should provide ongoing assistance to the affected population pending the restoration of appropriate services by the responsible authorities. In reality however, it takes at least a decade for most post-conflict governments to build the governance capacity, policies and institutions needed to provide an effective public health system. Even when large-scale reconstruction aid is provided by the international community, too much money is provided too early – during the first three years – when absorptive capacity is low, and resources are squandered. Then, just when absorptive capacity is increasing, the level of aid decreases (Collier and Hoeffler, 2002). Consequently, low-income, conflict-affected countries tend to suffer chronic failure of essential services and agencies end up replacing formal services rather than helping to bridge the transition between relief and reconstruction (World Bank, 2002)....