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Health cooperation objectives
- Page updated onMarch 10, 2025
Normally -although not always-, humanitarian and health cooperation actors intervene in crises and emergencies where there is a more or less fragile health system. Those who lead this health system have the obligation and mandate to respond to the needs of the population. When necessary, they must also request support from local and international health sector organizations and coordinate the joint response. In other cases, however, the pre-existing health system collapses or fails to reach the affected population.
The intervention approach of humanitarian actors and health cooperation actors must adapt to the context. This means working with different objectives and different approaches depending on the magnitude and type of crisis, the triggers, the capacity of the health services, and the willingness of the authorities to assume their duties with impartiality where there is a need, including areas where these authorities are not accepted.
Table of contents:
Direct provision of health services
Reaching where the national health care system does not reach
There are areas where the health system does not exist, does not have access, does not have the capacity to offer essential services or is unwilling to do so. In these areas, humanitarian and health cooperation organizations must assume the responsibility to do so. This is especially important in contexts of acute emergencies or in population displacements to areas where the service network is not sufficient.
In such cases, the humanitarian health response has the priority of establishing temporary fixed or mobile health services. These make it possible to ensure a minimum level of availability and access, in coordination with other actors and authorities. However, this type of intervention can lead to fragmentation of the system and its service provision. In addition, they can lead to increased costs or end up weakening the ailing health system. It is therefore necessary to evolve towards another type of more sustainable approach as soon as the needs or the context allow it (always without leaving the population unattended).
Emergency medical equipment
An example of this type of approach is the Emergency Medical Teams Initiative, launched in 2015 and dedicated to training these teams in countries that wish to join the initiative. These professional teams, obliged to meet minimum technical and training, quality and equipment standards, can be deployed in the national territory or in other countries in case of emergency within a maximum of 72 hours. These health cooperation teams can be mobile or fixed, ambulatory, with capacity for hospitalization and intensive care or specialized in specific health care areas.
There are also NGOs such as Médecins Sans Frontières (MSF), specialized in emergency medical care (among other things) in very complex humanitarian contexts of difficult access and high need.
Support for essential health services
Recovering essential services and preparing them for new shocks
In most cases, the most common health intervention approach is to offer support to the health system. This occurs especially when the situation becomes relatively stable and enters a post-emergency phase or becomes a protracted humanitarian crisis that may last for years, Thus this approach in many accompanies in the transition between direct emergency assistance and long-term strengthening.
This approach aims to recover and help maintain a minimum functional capacity of essential services and ensure access of the affected population to these services. It also seeks to achieve a certain level of preparedness to be able to respond to new shocks or the reappearance of the causes that provoked the humanitarian crisis. This approach to health cooperation helps to mitigate the negative impact of the crisis on essential services and contributes to restoring their functionality.
What differentiates this support from a longer-term strengthening approach is that support focuses primarily on inputs or actions to sustain the minimum capacity of services. This approach does not go into pursuing more systemic changes around health policies, relationships between areas and structures, efficiency or equity.
Examples of health services support activities
Some examples of support activities to the different elements of the health system include, among others:
- Training sessions and in-service training for health personnel who assume functions that go beyond their education and experience.
- Rehabilitation of damaged infrastructure and facilities.
- Provision of medical products (such as essential drugs and other products) and support for their management.
- Technical support for epidemiological surveillance and outbreak control.
- Cofinancing of health services and salaries of essential personnel, or reimbursement of the cost of providing certain essential services to the affected population.
- Technical and financial assistance for the provision of specific essential services such as vaccination campaigns.
Strengthening of the health system
Cooperation in health that seeks lasting and sustainable transformation
Health system strengthening is an approach, generally medium and long term, that goes beyond support for essential services. This type of health cooperation seeks a sustainable transformation and improvement of the health system of a health area or a country. It is carried out with the leadership and involvement of its authorities. It aims to improve the performance, equity, quality and efficiency of the system, for better population health outcomes.
Health systems strengthening interventions have strong links to their governance and leadership. They often contribute to developing policies for addressing social determinants of health or the scope of universal health coverage, along with plans for their implementation. They can also be aimed at modifying the internal organization of the system and its processes (for example to put primary care at the center). It can even help to transform how it is financed, for example.
Health system strengthening activities often require specialized technical assistance and the involvement of highly experienced professionals.
Technical assistance and advocacy
Strengthening the health system is not only a technical issue but also a matter of political will. Therefore, it must include advocacy actions with the objective of influencing the authorities in the acquisition of governmental commitments, their realization, and accountability.
For example, advocacy actions can be directed towards universal health coverage or greater public investment. It can also be accompanied by social mobilization to empower the population in their demands for the right to health. Advocacy can also pursue many other changes. These include, for example, implementing a health unit accreditation system, monitoring health spending, developing and implementing an emergency preparedness and response plan, implementing a computerized health information system, implementing a plan to increase health worker job satisfaction and retention, participating in the development of strategic plans and policies, or implementing a strategy for rational antibiotic prescribing.
All of these actions target profound changes beyond the provision of essential services. Moreover, they have the potential to produce a lasting positive impact, lasting long after project completion.
The reality: health cooperation with multiple approaches at the same time
Substitution, support and strengthening can coexist
In practice, in many crises and contexts, these approaches are often mixed together. Thus, an organization may end up combining actions from several approaches in a single program, or collaborating with other organizations, each maintaining specialization in one type of action.
In health cooperation, political advocacy and technical assistance is often provided to help improve aspects of governance or apply more equitable health care financing models, while support is given in certain units to ensure the availability of essential services to a minimum standard. In addition, and simultaneously, a mobile health team can be deployed to provide care in geographic areas that are difficult to access or where entire groups of internally displaced persons have relocated, who may show rejection of the authorities that have forced their flight.
The traditional model of direct health care is being challenged.
For several years now, the traditional model of health care for refugees has been questioned. This approach, coordinated under the umbrella of UNHCR, usually consists of setting up clinics run by international NGOs in refugee camps, outside the local health system.
This model, in addition to generating dependency, does little to strengthen the national health system or to prepare it for new crises. Moreover, it can create tensions if the host population cannot access these new services, which may be better than those that existed before their arrival. It is also a model that is also unsustainable in protracted humanitarian crises, which are becoming increasingly frequent.
The New York Declaration of 2016 and the Global Compact on Refugees of 2018, both under the framework of the United Nations and resulting from the impulse of the Grand Bargain, are committed to the integration of refugees into the health and social protection systems of the countries that host them. This, evidently, should go hand in hand with efforts to strengthen local health systems and improve their quality, thus making the strengthening of the health system what makes it possible to guarantee the humanitarian response to the needs of refugees. All of this fits with a Nexus approach.
Health fundamentals
External links
- Sphere, 2018. Health, in the Sphere Handbook.
- WHO. Emergency Medical Teams.
- Colombo, Pavignani, 2017. Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?
- Chee, 2013. Why differentiating between health system support and health system strengthening is needed.
- Elnakib, 2024. How integration of refugees into national health systems became a global priority: a qualitative policy analysis.
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