Fertility and reproductive health issues more broadly have tended to be of low priority in humanitarian crises. Public attention is drawn by information concerning the magnitude of refugee flows, of death tolls, and of numbers of injuries. Reproductive health has been regarded as a longer term issue that could safely be put on the back burner during the crisis phase of an emergency, when issues of providing adequate food, clean water, and shelter, plus treating acute infectious diseases of crowding, take priority. This report reviews what evidence there is concerning the effects of humanitarian crisis on fertility, with a view to identifying common patterns that may exist across settings and be of value in guiding responses to future crises.
Providing medical support to the local population during a chronic crisis is difficult. The crisis in the Democratic Republic of the Congo (DRC), which is characterized by high excess mortality, ongoing armed violence, mass forced displacement, interference by neighboring countries, resource exploitation, asset stripping, and the virtual absence of the state, has led to great poverty and a dearth of funds for the support of the health system.
International nongovernmental organizations (NGOs) have stepped in to address the dire humanitarian situation. This study looks at four organizations that support local health care in the eastern DRC: the International Rescue Committee (IRC), Malteser, Medical Emergency Relief International (Merlin), and the Association Régionale d'Approvisionnement en Médicaments Essentiels (ASRAMES). The study makes a comparison of the management and financing approaches of these four organizations by collecting and comparing qualitative and quantitative data on their interaction with the (remaining) local health providers and the local population.
Specific objectives of the study are:
1. To identify which management and financing approaches, including the setting of fees, are used by the four NGOs supporting healthcare in the eastern DRC. 2. To determine how these financing approaches affect utilization rates in the health zones supported by the four NGOs. 3. To assess how these utilization rates compare with donor and humanitarian standards. 4. To determine at what level fees must be set to allow for cost recovery or cost sharing in health facilities. 5. To identify the managerial problems confronting the four NGOs.
Many epidemiological and public health studies focus on the interaction between health providers and target groups. Supporting Local Health Care in a Chronic Crisis: Management and Financing Approaches in the Eastern Democratic Republic of the Congo concentrates more on how the relationship between the supporting NGOs and the local health system actually develops. In addition, a common aspect of many of the epidemiological and public health studies is the search for an optimal, or at least appropriate, management and financing approach.
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