We continued to explore the data such as using indices, combining data sets from multiple years, and so on. By the end of the course I got a good grasp of what could be done with R, but I probably need much more practice to use R comfortably!
I used R to analyse the data for my dissertation but I have gone rusty since then (as I found out when doing the data analysis MOOC) and this is my attempt to keep my skills sharp!
Why R? R is an industry-standard tool in the field of data science, and allows for robust data analysis. Week 1 went through the basics of importing data in R, extracting the head and tail of a data set, creating subsets, and identifying properties of the data set.
Week 3 considers changing needs and trends, and explores innovations in health for emergencies.
New and continuing challenges
The history of humanitarian in conflict began with the French Revolutionary and Napoleonic Wars between 1793 and 1814. Humanitarian aid began formally in the 19th century, when state, religious, commercial and philanthropic actors became involved in famine and relief efforts. Since then, every large crisis has been crucial for developing parts of the humanitarian system, such as the Second Italian War of Independence (leading to the creation of the International Committee of the Red Cross), first world war, Nigerian Civil War and so on.
Global trends in humanitarian crises include the rise of intrastate conflict, the increase in urban crises, responding in middle-income settings, the upward trend in natural disasters, and emerging infectious diseases. These pose different challenges in the way humanitarian actors respond.
Over the past century, there has been an epidemiological shift from infectious diseases to non-communicable diseases (NCDs). Other health burdens such as mental health and reproductive issues have begun to gain attention.
The future of humanitarianism
The Humanitarian Policy Group argues the the humanitarian system is facing a crisis of legitimacy, partly because it has been operating in the same way since the end of the Second World War. Therefore it is time for the humanitarian system to let go of: power and control; perverse incentives, and; unhelpful divisions.
Other stakeholders discussed included the private sector, civil society organisations and local responders. There is a need to build the capacity of individual humanitarians. In humanitarian response, parallel health systems should be avoided and countries’ development plans should be built upon. More attention is being paid to cash-based transfers while the needs of internally displaced persons (IDPs) have been neglected.
Innovation and technology
It is essential to develop innovative processes, protocols and tools to adapt to this new reality. Humanitarian innovation is a means of adaptation and improvement through finding and scaling solutions to problems, in the form of products, processes or wider business models… these may include technology but is not reducible to it (OCHA).
Week 2 looks at developing evidence-informed responses to humanitarian health needs, highlighting key mechanisms in place for conducting humanitarian aid and the practical challenges of delivering care.
Practicalities of working in humanitarian settings
Planning and coordinating an effective response is highly complex and time-sensitive. Rapid and appropriate action is critical to reduce avoidable illness and death.
Emergency preparedness and response plans (EPREPs), if available in the country and among agencies, help speed up response time. Data collection starts immediate to help with inform key priorities and decisions in the first few hours and days. Ways to collect data in humanitarian settings include the country’s health management and information system (HMIS), the early warning and alert response system (EWARS), health resource availability mapping system (HeRAMS), OCHA’s 4W tool (who, what, where, when) and multi-cluster initial and rapid assessments (MIRA), as well as community-based surveillance.
Guidelines can assist humanitarian agencies in prioritising their interventions. In emergency settings the main aim of healthcare is to reduce excess mortality and morbidity, after which a more comprehensive healthcare package can be offered
Key challenges in healthcare delivery
Numerous challenges can be faced when delivering healthcare, particularly in conflict scenarios. Sector-specific challenges include infectious disease, non-communicable diseases, mental health, nutrition and sexual and reproductive health.
Research is necessary to inform and advocate for humanitarian response. Fundamentally, it is about understanding the context and building a sense of security and trust during humanitarian response. Evidence is also gathered to improve interventions in the future. In 2015, an evidence review of health interventions in humanitarian crises described our existing knowledge and key gaps. For example, there is very little evidence available on water, supply and hygiene (WASH) interventions.
Summary of Week 1 of the FutureLearn course on Health in Humanitarian Crises (London School of Hygiene and Tropical Medicine)
What are humanitarian crises?
There is no universally recognised definition for humanitarian crises, but the course defined a humanitarian crisis as ‘an event or series of events that represent a critical threat to the health, safety, security, or wellbeing of a community or other large group of people, usually over a wide area’.
Humanitarian crises can be man-made, natural or complex, where complex emergencies are typically conflict-related and ‘requires an international response that goes beyond the mandate or capacity of any single agency, and which has been assessed to require intensive and extensive political and management coordination’ (Inter-Agency Standing Committee).
The crises can impact all levels of society, from individuals and families to economic and structure components, with vast and far-reaching consequences.
Crises and health
Mortality is probably the most important indicator of health needs in a humanitarian crises, and of the effectiveness of health response. Other key health outcomes include non-communicable diseases, mental health, sexual and reproductive health, and nutrition.
Humanitarian crises can have a major effect on the infrastructure and human resources of healthcare systems. Healthcare systems can be viewed in terms of 6 building blocks: health services; health workforce; health information system; medical products and technologies; health financing, and; leadership and governance (World Health Organisation (WHO) Health Systems Framework).
Cross-cutting issues such as disability, being elderly and gender have an impact on every aspect of health because they are more vulnerable in a humanitarian crisis. And challenges that affect the delivery of healthcare include: health financing, policy and donor priorities; safety and security, and; logistics.