Valerie Percival

Environmental Scarcity and Violent Conflict: The Case of South Africa

The causal relationship between environmental scarcities - the scarcity of renewable resources - and the outbreak of violent conflict is complex. Environmental scarcity emerges within a political, social economic, and ecological context and interacts with many of these contextual factors to contribute to violence. To examine this relationship, we outline a theoretical framework defining scarcities, the social effects arising from these scarcities, and the ensuing movement towards violence. We subsequently apply this framework to analyse the link between environmental scarcities and violent conflict in South Africa. Within South Africa, violence arose at precisely the same time that many anticipated a transformation to a more peaceful society - upon the release of Nelson Mandela, the end of the ban on political activity and the official end to apartheid. This article provides a new perspective on these events by analysing the link between South Africas environmental scarcity and violent conflict.

Environmental scarcity and violent conflict: the case of Rwanda.

On April 6,1994, President Juvenal Habyarimanas plane exploded in the skies above the Kigali region of Rwanda. Violence gripped the country. Between April and August of 1994, as many as 1 million people were killed and more than 2 million people became refugees. Until this recent violence, Rwanda had a population of 7.5 million, a population growth rate estimated at about 3%, and a population density among the highest in Africa. Ninety-five percent of the population resided in the countryside, and 90% relied on agriculture to sustain themselves. Land scarcity and degradation threatened the ability of food production to keep pace with population growth. Rwanda can be described as a country with severe demographic stress, relying for subsistence on a limited resource base. Although environmental factors were significant development issues, environmental scarcity had at most a limited, aggravating role in the recent conflict.

A case study of health sector reform in Kosovo.

The impact of conflict on population health and health infrastructure has been well documented; however the efforts of the international community to rebuild health systems in post-conflict periods have not been systematically examined. Based on a review of relevant literature, this paper develops a framework for analyzing health reform in post-conflict settings, and applies this framework to the case study of health system reform in post-conflict Kosovo. The paper examines two questions: first, the selection of health reform measures; and second, the outcome of the reform process. It measures the success of reforms by the extent to which reform achieved its objectives. Through an examination of primary documents and interviews with key stakeholders, the paper demonstrates that the external nature of the reform process, the compressed time period for reform, and weak state capacity undermined the ability of the success of the reform program.

Health systems and gender in post-conflict contexts: building back better?

The post-conflict or post-crisis period provides the opportunity for wide-ranging public sector reforms: donors fund rebuilding and reform efforts, social norms are in a state of flux, and the political climate may be conducive to change. This reform period presents favourable circumstances for the promotion of gender equity in multiple social arenas, including the health system. As part of a larger research project that explores whether and how gender equity considerations are taken into account in the reconstruction and reform of health systems in conflict-affected and post conflict countries, we undertook a narrative literature review based on the questions “How gender sensitive is the reconstruction and reform of health systems in post conflict countries, and what factors need to be taken into consideration to build a gender equitable health system?” We used the World Health Organisation’s (WHO) six building blocks as a framework for our analysis; these six building blocks are: 1) health service delivery/provision, 2) human resources, 3) health information systems, 4) health system financing, 5) medical products and technologies, and 6) leadership and governance.The limited literature on gender equity in health system reform in post conflict settings demonstrates that despite being an important political and social objective of the international community’s engagement in conflict-affected states, gender equity has not been fully integrated into post-conflict health system reform. Our review was therefore iterative in nature: To establish what factors need to be taken into consideration to build gender equitable health systems, we reviewed health system reforms in low and middle-income settings. We found that health systems literature does not sufficiently address the issue of gender equity. With this finding, we reflected on the key components of a gender-equitable health system that should be considered as part of health system reform in conflict-affected and post-conflict states. Given the benefits of gender equity for broader social and economic well-being, it is clearly in the interests of donors and policy makers to address this oversight in future health reform efforts.

Webcast the World Health Assembly

Once a year, delegates of WHO member states gather in Geneva for the World Health Assembly (WHA) to establish WHO’s priorities and programmes for the coming year. Those health practitioners, scholars, advocates, and journalists who are brave (or foolish) enough to come to the event jostle for credentials and queue for security, after spending thousands of dollars and burning tanks of jet fuel, with no guarantee of having a seat in the small public gallery.

Are health systems interventions gender blind? examining health system reconstruction in conflict affected states

BackgroundGlobal health policy prioritizes improving the health of women and girls, as evident in the Sustainable Development Goals (SDGs), multiple women’s health initiatives, and the billions of dollars spent by international donors and national governments to improve health service delivery in low-income countries. Countries recovering from fragility and conflict often engage in wide-ranging institutional reforms, including within the health system, to address inequities. Research and policy do not sufficiently explore how health system interventions contribute to the broader goal of gender equity.MethodsThis paper utilizes a framework synthesis approach to examine if and how rebuilding health systems affected gender equity in the post-conflict contexts of Mozambique, Timor Leste, Sierra Leone, and Northern Uganda. To undertake this analysis, we utilized the WHO health systems building blocks to establish benchmarks of gender equity. We then identified and evaluated a broad range of available evidence on these building blocks within these four contexts. We reviewed the evidence to assess if and how health interventions during the post-conflict reconstruction period met these gender equity benchmarks.FindingsOur analysis shows that the four countries did not meet gender equitable benchmarks in their health systems. Across all four contexts, health interventions did not adequately reflect on how gender norms are replicated by the health system, and conversely, how the health system can transform these gender norms and promote gender equity. Gender inequity undermined the ability of health systems to effectively improve health outcomes for women and girls. From our findings, we suggest the key attributes of gender equitable health systems to guide further research and policy.ConclusionThe use of gender equitable benchmarks provides important insights into how health system interventions in the post-conflict period neglected the role of the health system in addressing or perpetuating gender inequities. Given the frequent contact made by individuals with health services, and the important role of the health system within societies, this gender blind nature of health system engagement missed an important opportunity to contribute to more equitable and peaceful societies.

Gender equality needs critical consideration in conflict-affected settings

The World Banks 2012 World Development Report calls for gender equality on a global level but falls short on its analysis of conflict-affected contexts. It is critical that we understand the needs of vulnerable populations in these settings. This viewpoint draws on findings from research in health reform in conflict-affected contexts to highlight some opportunities and challenges for addressing gender equality in these settings, using the policy priorities outlined in the World Bank report. Drawing on this analysis we argue that more attention and action should be focused on addressing gender inequalities and inequities in neglected conflict-affected states.

Instruments for Global Health Diplomacy in the UN System Beyond the WHO

This chapter explores the practice of health diplomacy in four forums of the United Nations (UN): the General Assembly, the Security Council, the Economic and Social Council, and the Human Rights Council. Although health is not central to their mandate, over the past decade, Member States have placed health on these institutions’ agendas. The increasing amount of health diplomacy in these UN forums reflects the incorporation of global health objectives into the foreign policy goals of Member States and the recognition that diplomatic action in multiple forums is critical for the achievement of global health goals. Health diplomacy has created new global health norms, established new health institutions (UNAIDS), and obliged states to report on their fulfillment of global health commitments. For each forum, we describe how Member States utilize these institutions to address global health challenges.

Health diplomacy and humanitarian action: uncharted territory.

doi: 10.1017/S1049023X1200009X Introduction Humanitarian emergencies capture the public’s attention. Television images and newspaper stories convey scenes of civilians f leeing violence or the devastating and indiscriminate impact of natural disasters and depict the life-saving interventions of health professionals. Behind these public images of humanitarian action lies a complex machinery of multilateral agencies, trans-national non-governmental organizations, donor governments, and national-level agencies. While these organizations are united by the objective to alleviate suffering and improve population health, humanitarian groups’ interactions are not without acrimony or debates regarding effectiveness. Key debates include how to enhance the professionalism of humanitarian personnel; how to increase coordination and collaboration among international and national groups without undermining humanitarian principles of independence and neutrality; the role of the military and private security firms in humanitarian action; and how to increase efficacy of humanitarian response in diverse operational environments, such as urban settings. The active engagement of humanitarian professionals in applied research is critical to addressing these debates and improving the humanitarian response. The Harvard Humanitarian Initiative’s (HHI) Humanitarian Action Summit, held in 2010 on March 4-6, exemplifies such engagement. The Summit attracts practitioners currently active in humanitarian settings, together with researchers and government officials. The Summit is unique, combining expert presentations with the creation of working groups where participants collaborate to share and develop solutions to overcome challenges. Working groups continue their activities between Summits, facilitating ongoing collaboration and professional development among participants.