The Institute for Global Health and Development
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9
Browse
9 results
Search Results
Item Livelihood resilience and adaptive capacity: A critical conceptual review(AOSIS, 2012-10-16) Nyamwanza, AdmireThe concepts resilience and adaptive capacity have gained currency in ecology, climate change, disaster risk reduction and related development discourse; yet there has been almost an absence of clarity in the understanding, substance, definition as well as applicability of these concepts in livelihoods theory and practice – where they can potentially contribute far-reaching insights vis-à-vis long-term response to livelihoods adversity in different communities. Drawing upon literature from several disciplines utilising these concepts, this article traces the roots and evolvement of the resilience and adaptive capacity concepts and suggests indicators and pillar processes towards their integration into livelihoods thinking. This article therefore mainly contributes towards the conceptualisation and understanding of a focused ‘resilience and adaptive capacity’ construct in livelihoods analysis.Item Climate change, sustainable water management and institutional adaptation in rural sub-Saharan Africa(Springer, 2016-01-20) Nyamwanza, Admire; Kujinga, Krasposy K.Much current work on climate adaptation options vis-à-vis water management in rural sub-Saharan Africa has tended to focus more on technological and infrastructural alternatives and less on institutional alternatives. Yet, vulnerability to climate variability and change in these contexts is a function not just of biophysical outcomes but also of institutional factors that can vary significantly at relatively finer scales. This paper seeks to contribute towards closing this gap by examining institutional options for sustainable water management in rural SSA in the context of climate change and variability. It explores challenges for transforming water-related institutions and puts forward institutional alternatives towards adapting to increasingly complex conditions created by climate change and variability. The paper suggests revisiting the Integrated Water Resources Management approach which has dominated water institutional debates and reforms in Africa over the recent past, towards actively adopting resilience and adaptive management lenses in crafting water institutional development initiatives.Item Sustainability: a missing dimension in climate change adaptation discourse in Africa?(Taylor and Francis Group, 2018-04-25) Bhatasara, Sandra; Nyamwanza, AdmireThe climate change adaptation field has evolved considerably in recent years. Important contributions have been made, with scholars developing methods for assessing vulnerability in different countries and communities, documenting broad strategies for adaptation and identifying opportunities for and barriers to adaptation as well as ways to enhance adaptive capacity. Issues of sustainability are, however, not readily argued and embraced. Predominantly, our analysis exposes that current adaptation discourse, particularly in Africa, offers a narrow conceptualisation of sustainability. The paper argues for a clear framework of sustainability in adaptation discourse which encompasses awareness to contextual aspects in responding to climate variability and change as well as resilience aspects. The paper also calls for an expansion of the knowledge base around the concept of ‘climate-smart agriculture’ towards effectively incorporating sustainability aspects in climate change adaptation discourse.Item Understanding fragility: Implications for global health research and practice(Oxford University Press, 2019-12-10) Diaconu, Karin; Falconer, Jennifer; Vidal, Nicole L.; O'May, Fiona; Azasi, Esther; Elimian, Kelly; Bou-Orm, Ibrahim; Sarb, Cristina; Witter, Sophie; Ager, AlastairAdvances in population health outcomes risk being slowed—and potentially reversed—by a range of threats increasingly presented as ‘fragility’. Widely used and critiqued within the development arena, the concept is increasingly used in the field of global health, where its relationship to population health, health service delivery, access and utilization is poorly specified. We present the first scoping review seeking to clarify the meaning, definitions and applications of the term in the global health literature. Adopting the theoretical framework of concept analysis, 10 bibliographic and grey literature sources, and five key journals, were searched to retrieve documents relating to fragility and health. Reviewers screened titles and abstracts and retained documents applying the term fragility in relation to health systems, services, health outcomes and population or community health. Data were extracted according to the protocol; all documents underwent bibliometric analysis. Narrative synthesis was then used to identify defining attributes of the concept in the field of global health. A total of 377 documents met inclusion criteria. There has been an exponential increase in applications of the concept in published literature over the last 10 years. Formal definitions of the term continue to be focused on the characteristics of ‘fragile and conflict-affected states’. However, synthesis indicates diverse use of the concept with respect to: level of application (e.g. from state to local community); emphasis on particular antecedent stressors (including factors beyond conflict and weak governance); and focus on health system or community resources (with an increasing tendency to focus on the interface between two). Amongst several themes identified, trust is noted as a key locus of fragility at this interface, with critical implications for health seeking, service utilization and health system and community resilience.Item Health system resilience in the face of crisis: Analysing the challenges, strategies and capacities for UNRWA in Syria(Oxford University Press, 2019-10-18) Jamal, Zeina; Alameddine, Mohamad; Diaconu, Karin; Lough, Graham; Witter, Sophie; Ager, Alastair; Fouad, Fouad M.Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. We examined the case of the United Nations Relief and Works Agency (UNRWA) and its delivery of services to Palestine refugees in Syria during the ongoing crisis to identify factors enabling system resilience. The study is a retrospective qualitative case study utilizing diverse methods. We conducted 35 semi-structured interviews with UNRWA clinical and administrative professionals engaged in health service delivery over the period of the Syria conflict. Through a group model building session with a sub-group of eight of these participants, we then elicited a causal loop diagram of health system functioning over the course of the war, identifying pathways of threat and mitigating resilience strategies. We triangulated analysis with data from UNRWA annual reports and routine health management information. The UNRWA health system generally sustained service provision despite individual, community and system challenges that arose during the conflict. We distinguish absorptive, adaptive and transformative capacities of the system facilitating this resilience. Absorptive capacities enabled immediate crisis response, drawing on available human and organizational resources. Adaptive capacities sustained service delivery through revised logistical arrangements, enhanced collaborative mechanisms and organizational flexibility. Transformative capacity was evidenced by the creation of new services in response to changing community needs. Analysis suggests factors such as staff commitment, organizational flexibility and availability of collaboration mechanisms were important assets in maintaining service continuity and quality. This evidence regarding alternative strategies adopted to sustain service delivery in Syria is of clear relevance to other actors seeking organizational resilience in crisis contexts.Item Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria(Elsevier, 2018-10-21) Alameddine, Mohamad; Fouad, Fouad M.; Diaconu, Karin; Jamal, Zeina; Lough, Graham; Witter, Sophie; Ager, AlastairResilience is increasingly recognised 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 with respect to the functioning of United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health systems in Lebanon and Jordan in the context of the Syrian crisis. We 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 analysed through inductive thematic analysis and used to critically interrogate health systems resilience against a pro-capacities framework. We find that UNRWA systems in Lebanon and Jordan were broadly resilient, deploying diverse strategies to address health challenges and friction between host and refugee populations. Absorptive capacity was evidenced by successful accommodation of increased patient numbers across most service areas. Adaptive capacities were reflected in broadening of collaboration and reconfiguration of staff roles to enhance service delivery. Transformative capacities were demonstrated in the revision of the service packages provided. While manifest as technical capacities, these clearly drew upon solidarity and commitment linked to the political context of the Palestinian experience. 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. The proposed resilience framework promises to guide strategies for sustained care delivery in these contexts.Item Health workers' experiences of coping with the Ebola epidemic in Sierra Leone's health system: A qualitative study(BioMed Central, 2018-04-05) Raven, Joanna; Wurie, Haja; Witter, SophieThe 2014 Ebola Virus Disease epidemic evolved in alarming ways in Sierra Leone spreading to all districts. The country struggled to control it against a backdrop of a health system that was already over-burdened. Health workers play an important role during epidemics but there is limited research on how they cope during health epidemics in fragile states. This paper explores the challenges faced by health workers and their coping strategies during the Ebola outbreak in four districts - Bonthe, Kenema, Koinadugu and Western Area - of Sierra Leone.Item Interrogating resilience in health systems development.(OUP, 2017-09-23) van de Pas, Remco; Ashour, Majdi; Kapilashrami, Anuj; Fustukian, SuzanneThe Fourth Global Symposium on Health Systems Research was themed around 'Resilient and responsive health systems for a changing world.' This commentary is the outcome of a panel discussion at the symposium in which the resilience discourse and its use in health systems development was critically interrogated. The 2014-15 Ebola outbreak in West-Africa added momentum for the wider adoption of resilient health systems as a crucial element to prepare for and effectively respond to crisis. The growing salience of resilience in development and health systems debates can be attributed in part to development actors and philanthropies such as the Rockefeller Foundation. Three concerns regarding the application of resilience to health systems development are discussed: (1) the resilience narrative overrules certain democratic procedures and priority setting in public health agendas by 'claiming' an exceptional policy space; (2) resilience compels accepting and maintaining the status quo and excludes alternative imaginations of just and equitable health systems including the socio-political struggles required to attain those; and (3) an empirical case study from Gaza makes the case that resilience and vulnerability are symbiotic with each other rather than providing a solution for developing a strong health system. In conclusion, if the normative aim of health policies is to build sustainable, universally accessible, health systems then resilience is not the answer. The current threats that health systems face demand us to imagine beyond and explore possibilities for global solidarity and justice in health. [Abstract copyright: The Author 2017; all rights reserved. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.]Item Resiliency of children in child-headed households in Rwanda: implications for community based psychosocial interventions(2009) Ward, Laura May; Eyber, CarolaThis article focuses on the resilience of children facing extreme hardship and adversity. It is based on participatory research with children living in child headed households in Rwanda. It emphasizes the importance of listening to children's voices and recognizing their capacities when designing interventions to strengthen their psychosocial wellbeing. This study shows that children have developed innovative and profitable coping strategies and some have even developed the capacity to thrive through their situation of extreme hardship. The study of these coping strategies suggests that the children displayed resourcefulness, responsibility, and a sense of morality. However, when the stressors in a child's life became too great, they tended to employ negative, and potentially harmful, strategies to cope. A community based approach should focus on strengthening overall community wellbeing, and should aim to build on the capacities of children, such as their positive coping mechanisms and resilient characteristics. At the same time, it should appropriately address their areas of vulnerability. Existing protective factors should also be identified and further developed in interventions. (C)2009 War Trauma Foundation