Health responses to humanitarian crises must change fast

How can we mitigate future crises?

The global humanitarian response system is creaking and facing new challenges just as it confronts unprecedented demand. Governments are often narrowing their roles and cutting funding for development assistance. Mitigating or even preventing future crises depends on developing leadership skills to enable programmes to be led from the communities they serve. The world also needs “unusual partnerships”, as one participant put it at a conference that I helped moderate recently.

The Partnership for Quality Medical Donations conference is always under the Chatham House Rule, so I can tell you what I learned but not who said which bit of it. It’s the great strength of the annual meeting, but also a pity because the meeting brings together senior figures from the pharmaceutical, medical devices and diagnostics industries with their peers from major humanitarian groups. Ambassadors, policy makers and the heads of foundations and philanthropies help keep the conversation honest.

Attempts at global coordination are just getting in the way

“The system set up over the past twenty years to coordinate response and build specialist capacity is often just slowing things down” an experienced top leader told one conversation that I moderated. (The meeting is deliberately not recorded and I couldn’t make comprehensive notes while I was guiding the discussion, so these are reconstructions from memory). One organisation had waited months for instructions and clearance from Unicef and the Geneva institutions to provide health services in Gaza; others had simply gone in and started work with whatever equipment had arrived.

The alternative to the chaos of the 1990s, when every organisation worked without coordination, may be a much more dynamic alignment of companies, charities, governments, faith groups and others. The challenge is to be sure that the assistance offered actually matches local needs and priorities — “having local voices at the table is great, but how do you decide who should be there?” Important talk about more leadership from developing countries and a better gender balance in top roles will only become a reality if leaders can be equipped for new roles and if technical expertise can be matched with skill in managing power relationships.

The other problem, unfixed since the early days of humanitarian assistance is that resources often just chase the news agenda. “We always hold back some resources to fund services and reconstruction once the spotlight has moved on,” one participant told me. “And while we’re responding to Gaza and Ukraine, we need to keep our eyes on neglected crises such as the DRC and Sudan,” said another.

As one funding door narrows, another is opening

COVID taught us that we need a “whole of society” response to health emergencies and that, badly handled, health problems can destroy economies, livelihoods and communities. There may be fewer resources from overseas assistance funding than we have become used to this century, but health “isn’t an overseas development issue, it’s fundamental”. Global and regional development finance institutions seem to have recognised its importance and are willing to invest at scale. Like the rest of us, though, they sometimes find it difficult to work out who should set the agenda and who should respond. National governments are often slow, unwilling to involve community groups and too reluctant to spend their own money, but large initiatives are usually impossible without the state.

Subsidiarity is an old principle of social justice that decisions should be made as close as possible to those affected by them. It needs to underpin modern partnerships, not simply as a matter of social justice but because locally-made decisions are far more likely to be good, sustainable ones.

AI will help, if it doesn’t copy our biases

Shared decision-making and effective implementation partnerships will become more important as climate change accelerates. A global listening exercise suggested that the biggest worries centre on infectious disease — mosquito-borne illnesses are already reaching areas that had been too cold and water-borne diseases thrive amidst flooding and rising sea temperatures. Monitoring and merging of data sets will enable artificial intelligence to model scenarios and predict the likelihood of disease outbreaks.

Working out who to involve when and in what role may also become much easier if artificial intelligence can help in matching priorities, needs, capabilities and capacity. AI will tackle the increasingly-severe health staffing crisis too: it should extend the skills of community health workers and volunteers. By itself, though, it will not deliver fast enough; there needs to be an investment in small, quicker nursing and medical schools that train health professionals to work alongside technology, not to act as poor substitutes for it — “medical training hasn’t changed in a hundred years; we just don’t need to memorise things any more.”

AI is already super charging diagnostic and scanning technology. We should worry, though, that it may be copying and amplifying human biases: if all of the data fed into AI models comes from those who currently have access to healthcare, the machines will come to think that the world is far richer, whiter and older than it is. The Urban Institute is already working with one producer to help assure data diversity. As change accelerates, it may also be that the very latest technology is too difficult to deploy and to maintain in many underserved communities; the almost-new technology that is superfluous in the most sophisticated European and American hospitals could be transformative in the rest of the world.

The transformation of NGOs

Many of the international NGOs which respond to crises have already changed their way of working. Instead of setting policies and allocating resources centrally, they are creating multi-node networks and asking countries to bid for resources to meet local opportunities.

For big pharmaceutical, diagnostic and vaccine companies, the change may mean learning to love ad hoc partnerships and nimble coalitions rather than the grand initiative dreamt up at the office of a management consultancy. It may also mean building on what works, rather than jumping onto each fashionable float as it drifts through Davos. Companies that have grown programmes from long standing efforts benefit from the knowledge of local communities and a relationship of trust.