This project was made possible through Cooperative Agreement Number HRN-A-00-96-9006 between the US Agency for International Development and Tulane University

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Introduction: Rationale for Crisis Prevention, Mitigation and Recovery and Transition as a New Analytical Domain for Policy Analysis and Programming in Sub-Saharan Africa (SSA).

Conceptual Framework for Crisis Prevention, Mitigation and Recovery/Transition

Immediate Causes: Natural Hazards, Epidemics, and Conflicts

Underlying Causes: Ecology, Underdevelopment and Inappropriate Development Phases of Crisis

The Temporal Dimension of Crisis

Why Traditional Approaches to African Development are no Longer Appropriate

Conceptual Gaps

Programming Inefficiencies

An Outdated Political and Organizational Framework Within the Development Industry

CPMR Approaches and Strategy

Principles of Linking Relief and Development

The Central Role of Public Health and Human Security

Performance Monitoring of Interventions Across the Crisis Life Cycle is Critical

Systematic Mechanisms for Identifying Information Gaps and Disseminating Best Practices

Summary of a Strategy for Crisis Prevention, Mitigation and Recovery/Transition in SSA

“Humanitarian relief and disaster planning are integral to sustainable development. Manmade and natural disasters can wipe out years of development in a matter of minutes. The costs of clean-up, reconstruction, and adjustment associated with large-scale natural disasters can impose burdens on a national economy that persist for years. War, famine, and environmental damage can undermine development for decades to come. Annual losses from natural disasters now equal the total of official development assistance, so investments in prevention and mitigation promise a significant financial and strategic return.”

USAID Strategies for Sustainable Development, April, 2000

Rationale for Crisis Prevention, Mitigation and Recovery/Transition as an Important Analytical Domain for Policy Analysis and Programming in Sub-Saharan Africa (SSA).

Introduction

Although very recent economic and political events give reason for optimism, SSA remains a region in crisis. In the majority of countries development progress has been slow as is reflected by both human and economic indicators. In addition, SSA recently has experienced the highest frequency as well as the most serious consequences of disasters than any other region. The situation was well summarized by the Africa Regional Director of the World Health Organization who remarked recently that “the very hazards and vulnerabilities that originate the Region’s disasters have been the targets of more than thirty years of development, their persistence can be taken as a testimony to as many failures” and as a consequence, “out of a population of more than 744 million, 734 million live in countries that are considered to be disaster prone”.

The massive loss of lives, livelihood and infrastructure is clear in the cases of the recent catastrophic emergencies in Rwanda, Somalia, Mozambique, Sierra Leone and Liberia. While quantitative information on the economic costs of disasters are elusive because of the varied types of costs and poor financial information, available information shows that economic outputs of countries are reduced during major disasters and that available resources are consumed to mitigate impacts, in the case of drought-related famine; or to support military costs in the case of conflict-related disasters. Specific studies undertaken by UNICEF (1985) suggest that the impact of conflict and destabilization in southern Africa approached 25-40% of GNP annually. In countries directly involved in conflict, this percentage was much higher. Military expenditures alone exceeded 50% during the period of active conflict. Although natural disasters such as drought are frequently less costly, even in relatively developed countries such as Botswana, government expenditures on relief varied between 14-18% of total government expenditures during the drought of the 80’s (Buchanan-Smith, 1994). In Zimbabwe, the 1992 drought lead to a 25% reduction in the volume of economic output (Benson et al., 1994).

Crisis has eroded development investments in SSA. The frequency of disasters and their costs have dramatically increased during the past decade. International donor outlays for disaster assistance to SSA increased nearly nine fold between the mid 80’s and mid 90’s, while development budgets have stagnated or declined. In 1998, the United States Agency for International Development (USAID) spent more than 35% of its assistance package to SSA on emergencies.

A review of officially declared disasters during the past 25 years (those recorded by the Office of Foreign Disaster Assistance (OFDA) illustrates the changing character of disasters and crises in SSA. Although disasters due to the natural hazards of drought, pests and flooding have always been a recurrent threat to African development; more recently, in the wake of the cold war, armed conflict has resulted in a dramatic increase of Complex Emergencies (CEs). CEs are disasters characterized by political instability frequently combined with problems of food insecurity and health threats that lead to massive population migration.

Epidemic threats also are more critical to the development of SSA than anywhere else in the world. Although SSA accounts for only 10% of the world’s population, it contributes more than 20% of the world’s global burden of disease (World Bank, 1993). Unlike other regions, the majority of SSA’s disease burden is the result of infectious and parasitic diseases, which makes it unique in the world. The underlying risk of infectious and parasitic diseases can act as catalysts of far more consequential epidemics in this than other regions. The interaction between HIV and Tuberculosis is an obvious example. Populations with high levels of HIV infection are also at increased risk of epidemics caused by many infectious agents.

Natural disasters, epidemics and conflict-related disasters have occurred more frequently and with greater negative consequences in Africa than in any other region (see Figure 1). Epidemics and conflicts are far more frequent in Africa than anywhere else. Even in the area of disasters caused by natural hazards, Africa registers the highest numbers of declared disasters in the first half of the decade.

Figure 1- Worldwide Disaster Incidents – 1990-1994 (Source: OFDA Database)

This context of disasters and underdevelopment has given rise to the need for a crosscutting analytical domain for policy analysis and programming. We have termed this analytical domain Crisis Prevention, Mitigation and Recovery (CPMR). Strategies to achieve CPMR emphasize the multi-dimensional nature of crises in SSA and the intimate linkages between disasters and development. Also important is the need to examine and more carefully characterize the life cycle of crises and the temporal aspects of their evolution so that interventions can be dynamic and responsive to the rapidly changing needs of affected populations.

Effective CPMR has important implications for policy, programming and the organizational aspects of international development. Two basic approaches are central to improved CPMR in SSA. One is better integration and complementarity of relief and development interventions (linkage between relief and development). The second is more effective regional and national programs to address the question of crisis prevention in SSA in the areas of conflict, epidemics and natural hazards.

This paper develops a strategic framework for crisis prevention, mitigation, and recovery in SSA. Specifically, it 1) provides a conceptual framework illustrating the phases of crisis within which CPMR can operate, 2) reviews current approaches and strategies to dealing with crisis, and 3) puts forth a rationale for CPMR.

Conceptual Framework for Crisis Prevention, Mitigation and Recovery/ Transition

Understanding the nature of crises in SSA is aided by an analytical framework that distinguishes the various causes of disasters and crises (see Figure 2). The immediate causes of crises (see Figure 3) are natural hazards such as drought, flooding, pests, earthquakes; epidemics, such as cholera, measles, meningitis, ebola and HIV/AIDS;and armed conflicts such as those that gave rise to the CEs in Sierra Leone, Sudan, Burundi, Liberia, Ethiopia, Somalia, Rwanda, Angola, and Mozambique among others. Crises may or may not result in disasters depending upon the efficacy of interventions directed at mitigating the effects of exposure of populations to the immediate crisis threats.

The underlying causes of crises are those that give rise to the immediate causes or act synergistically with the immediate causes to produce massive population movements and to profound loss of life and livelihood. It is important to note that, with the exception of earthquakes and catastrophic floods and droughts, crisis threats in the developed world rarely result in such serious outcomes that external disaster assistance is needed. In order to understand the policy and program implications of CPMR, it also is useful to distinguish the phases of the crisis lifecycle and the different time trajectories of crises and disasters; there are both slow and rapid onset crises that have different implications for appropriate response.

Figure 2- The Causality of Crisis and Complex Emergencies

Figure 3- Categories and Immediate Causes of Crisis.

Immediate Causes: Natural Hazards, Epidemics, and Conflicts

In spite of their relative frequency and the large numbers they affect, natural disasters in Africa have resulted in very few deaths in recent years – a reflection, in part, of improved early warning and more effective response. Natural disasters are responsible for 28% of disaster-caused deaths recorded by OFDA from 1970 to 1994, while they accounted 57% of all those affected by disasters and 66% of all disaster-related homelessness or displacement. Drought accounts for over three-quarters of those affected by natural disasters in Africa and nearly all natural disaster-related mortality. Ethiopia, Chad, Botswana, Burkina Faso, Kenya, Mozambique and Mauritania are among the countries in Africa reporting the highest frequencies of drought related events.

Although no more frequent than natural hazards, for most of the 1970 to 1989 period, infectious disease epidemics claimed the greatest number of lives (Figure 4). This is the result of interactions among these immediate causes. Only since 1990 have conflict-related disasters overtaken epidemics as the major cause of disaster-related mortality. Yellow fever, cholera, and meningitis traditionally are among the diseases most often cited as the source of epidemic outbreaks in the region. Measles, malaria and dysentery are the major killers of children who are refugees or displaced as the result of any immediate threat. Recently, outbreaks of emerging diseases such as the ebola and lassa fever have also warranted serious concern and significant responses from the international community. Drug resistant malaria and Tuberculosis as well as HIV/AIDS are slow onset crises that have dramatic effects on the impacts of other immediate crisis threats. Slow onset crises interact with other crisis threats, such as conflict and forced migration to escalate the spread and ferocity of epidemic diseases.

Figure 4- Mortality by Disaster Type – 1970-1994 (Source: OFDA Database)

Currently, conflict-related crises represent the most serious threat to developmental initiatives in SSA. CEs claimed millions of lives during the 1990’s. They resulted in massive losses of human and physical infrastructure in Liberia, Democratic Republic of Congo, Sierra Leone, Somalia, Rwanda, Burundi, Chad, Mozambique, Angola and Uganda. Many other African countries remain on the watch lists of international donors, even though active crisis is not apparent. Even where conflicts are now abated, numerous countries are in a dynamic but fragile state of transition. They remain at risk of regressing into active conflict.

Underlying Causes: Ecology, Underdevelopment and Inappropriate Development

The close correlation between disasters and underdevelopment is now well understood by the development community. What is more, disasters and underdevelopment combine to create a vicious circle of human misery that is difficult to break. The Central Intelligence Agency (CIA) recently completed a study that illustrated this relationship at a global level. In an attempt to identify risk factors for conflict crises, a meta-analytic approach compared various development indicators between countries that recently experienced severe conflicts and those that did not. This analysis identified three significant predictors of conflict disasters. These were infant mortality rate, openness to external trade, and democratization.

SSA has the highest infant and child mortality rates in the world (see Figure 5). It also is disfavored in terms of international trade and democratization. Figures 5 to10 show that in terms of social development and economic growth, SSA countries, and particularly those experiencing recent crisis compare very unfavorably to other developing countries on several of these. In SSA both underdevelopment and inappropriate development provide a context ripe for disaster. Political instability, poverty and economic insecurity, poor and eroding social services and environmental degradation have undermined the livelihoods of millions in the region. Population movements associated with conflicts, disasters and economics strain fledgling economies in those parts of the region where economic progress is beginning to get underway.

While the 90’s have shown some improvement in the economic performance of most African countries, progress is a new development and it is modest. As recently as 1989, the World Bank completed a study entitled “Sub-Saharan Africa: from Crisis to Sustainable Development.” In this extensive study, the region was singled out as experiencing developmental losses, as indicated by any indicator chosen to measure general societal development. The report concluded that“Africa’s deepening crisis is characterized by weak agricultural growth, a decline in industrial output, poor export performance, climbing debt, and deteriorating social indicators, institutions, and environment” (World Bank, 1989).

Figure 5- Infant Mortality Rate in Selected African Countries and Low Income Countries (Source: World Bank)

Figure 6- Total Fertility Rates in Selected African Countries and Low Income Countries(Source: World Bank)

Figure 7- Average Changing in Per Capita Food Production for Seven African Countries Now Suffering or at Risk of Humanitarian Crisis 1979-1992(Source: FAO)

Figure 8- Primary School Enrollment as a Percentage of Age Group in Seven African Countries Now Suffering or at Risk of Humanitarian Crisis and in Low-Income Countries (Source:World Bank)

Figure 9- Annual Percentage Growth in Gross Domestic Product for Selected African Countries 1990-1998 (Source: World Bank)

In the early 1990s, three countries posted consistent economic progress. Ghana, Uganda and Tanzania posted per capita growth in GDP of more than 2% annually during that period. From 1988-93 investment as a percentage of GDP in sub-Saharan Africa was around 16% - the same as in the first half of the 1980s.

1995, however, marked a turning point in SSA economics. For the first time in two decades, the International Monetary Fund (IMF) posted positive economic growth in the vast majority of countries in SSA (see Figure 10). There is optimism that this will mark the beginning of a trend. However, given the volatile recent history of the region, guarded optimism is warranted.

Human development, too, lags behind other areas of the world and is projected to deteriorate on the whole. Figure 8 shows that primary school enrollment is low in many countries. Maternal literacy is the lowest in SSA than in any other region of the world. Some areas, such as the Sahel, can claim only a small percentage of literate mothers. In 1990, the World Bank projected that the numbers of people living below the poverty line would have grown from 180 million in 1985 to 265 million by the year 2000 as population growth outstrip the rate of economic progress.

The convergence of population pressure, poor health and poor socio-economic performance is more severe in Africa than in any other region. African fertility is among the highest in the world and movement towards the demographic transition has begun definitively only in Botswana, Kenya, and Zimbabwe – all middle-income African countries (see Figure 6).

Figure 10- Growth Rates of GDP and GNP for Selected African Countries (Source: World Bank)

Urbanization also will probably facilitate civil unrest when it leads to the growth of a large marginalized urban poor sector. In particular, population migration patterns and urbanization are confounding development programs that target rural areas. Although the pace of urbanization had slowed somewhat during the late 80’s (Hill et al, 1985), Africans were migrating from rural to urban areas more intensively than in any other region of the world. The United Nations estimates that, by 2025, almost 54% of all Africans will be urban residents (UN, 1995). More than two thirds of southern Africa’s population will be urban. Only in the eastern sub-region will the minority of residents reside in urban areas. Urbanization in Africa leads to lifestyle changes that have profound impacts on infectious disease ecology and epidemiology.

Other significant population movements are related to migrant workers who move from poorer, rural areas to more economically active urban areas in the region. These migration patterns have played an important role in the spread of HIV and other infectious diseases.

Phases of Crisis

Crises have various phases, each having distinct characteristics and requiring intervention priorities. Prevention, mitigation and recovery/transition are those elements of crisis programming that have not been seriously embraced by either the relief or development communities. Before a crisis emerges, early warning and preparedness programs can prevent and mitigate the effects of crisis threats. When crises have become full-blown disasters, response must be professional and compatible with longer term development objectives, or at least not antagonistic to them. Finally when the immediate crisis threat has faded, recovery/transition programs must address the specific needs of populations emerging from crisis. In the SSA context, transition programs have posed great challenges, as donors often have not sustained their interest in supporting populations once the immediate threats to survival have waned.

The Temporal Dimension of Crisis

Disasters and crises can be classified according to the temporal dynamics of their onset and duration. Crises can be either slow or rapid in onset and they can be of varying lengths in duration. In fact, in each of the major categories of crisis threats there are examples of this spectrum of progression. Disasters associated with natural hazards such as earthquakes and floods are rapid onset disasters; the hazard event and its consequences usually occur within seconds, hours, or days. Classical disaster response programs are typically implemented to ensure immediate survival of victims; however, international interest wanes as the recovery process unfolds. Droughts are usually slower in onset, occurring over months and in the case of major climatic cycles, years. Droughts and economic shocks associated with famines provide adequate warning to result in effective mitigation programs.

Epidemic crises provide examples of both rapid onset and very slowly evolving crises. Cholera and other diarrheal diseases can be very rapid (days, weeks) while HIV takes several years to develop into a crisis. Again, early warning and surveillance hold great promise for prevention and mitigation of epidemic crises. In Niger, USAID’s investments in information systems and the development of disaster preparedness plans resulted in the prevention of an epidemic during the early 1990s, despite the country’s low level of socioeconomic development.

Conflict crises and CEs, may be both rapid and slow in onset. In the SSA context, however, the duration of CEs has been very long, lasting years and decades. Most of the contemporary examples of conflict-precipitated CEs have lasted no less than five years. Until recently, there has been no emphasis on conflict prevention/mitigation, despite the fact that academic research points to the feasibility of early warning systems and promising approaches to preventing the outbreak of violent conflict. At the other end, the resolution of violent conflict has often marked the departure of international funds needed to ensure rapid transition to development. The absence of necessary political and financial support often results in regression into political instability.

The temporal dimensions of crises have important implications for CPMR. With foresight and good early warning and preparedness, there is great promise for prevention of the all too familiar sequelae of mortality, mass migration and destitution, if the political will to act exists.

Why Traditional Approaches to African Development Are No Longer Appropriate

Business as usual will no longer work in the African context for several reasons, outlined in the following sections. First, the relief-development paradigm loses its meaning as the landscape of crisis is increasingly frequent, severe and long-term. Second, resources are increasingly being diverted from development investment to humanitarian assistance along, with a general decline in publicly financed development work. Relief interventions have been shown to be inefficient at time and sometimes antagonistic to development goals.The organization and political framework of development agencies must be restructured to respond to these changes.

Conceptual Gaps

Traditional developmental approaches have assumed that developing countries are on a trajectory of improvement, depicted in Figure 11. In this case, disasters are perceived as a temporary disruption to the development process, requiring a particular set of time-bounded, survival-oriented interventions. As a result, development agencies have compartmentalized relief and development programming as separate and unrelated activities. Margaret Buchanan-Smith and her colleague Simon Maxwell (1994) astutely observed that for poor people in the developing world, “relief and development are inextricably bound together in the complex and day-to-day business of managing risk and securing livelihood”. The donor community has created an artificial distinction between relief and development problems.

A similar problem is that contemporary crisis threats, including natural hazards, conflicts and epidemics are often managed by unidisciplinary or unisectoral programs. This was one of the reasons that initial early warning systems attempts were unsuccessful. For example, the famine early warning system of the 70s and 80s collected and analyzed agro-meteorologic information. Only when population vulnerability and coping behaviors were factored in did these early warning systems yield effective prevention and mitigation tools.

Figure 11 - Crisis as Temporary Interruption to Development Activity (Source: Adapted from Peter Walker, ICRC, 1996)

DEVELOPMENT

CRISIS

TIME

A second limitation of many donor strategies is the country-focussed development employed by most. Internationally, levels of Official Development Assistance (ODA) are inversely related to poverty and instability (World Bank, 1995). Donors typically focus investments on a limited number of promising countries, ignoring their regional context. This pattern of investment has become greatly exaggerated since the end of the cold war.

Ignoring the regional nature of crisis threats may greatly diminish the developmental progress of focus countries. Epidemics, natural disasters, and even the aftermath of collapsed states are not defined by national boundaries. Without significant regional and sub-regional strategies to address crisis threats, the progress of individual countries will be slowed.

Programming Inefficiencies

As the region is increasingly riddled by full-blown disasters, the cost of external assistance is high and growing. Among all donors, total funding for emergency aid was estimated at $6 billion in 1995, 10 percent of all foreign aid (OECD, 1995). Figure 12 shows the dramatic climb in the value of humanitarian assistance from the U.S. and other OECD member states, from the early 1980s to the mid 1990s. Among U.S. government agencies, the Office for Foreign Disaster Assistance (OFDA) and the Office of Food For Peace increased cash and food grants for humanitarian relief in Africa four-fold between 1983 and 1994 (Natsios, 1995). In fiscal year 1994, USAID devoted more than 30% of its total assistance to disaster relief in Africa. In addition, more than 80% of all U.S.-supplied emergency food aid went to this crisis-afflicted region as well (USAID Annual Report on Program Performance, 1994).

While expenditures on disaster relief have been climbing, funding available for development programs has been stagnant and declining. Because the relief and development response of international agencies is almost completely compartmentalized, relief and development interventions are rarely designed to be complementary. In fact, numerous recent evaluations have shown that they are often antagonistic (Duffield, 1994; Buchanan-Smith, Maxwell, 1994). Although the knowledge base is inadequate to evaluate the quantitative costs of these inefficiencies, it is clear that complementarity between relief and development interventions is critical in an era of declining public investment in international development.

The Need for Restructuring the Outdated Political and Organizational Framework Within the Development Agencies and Organizations

The development agencies and organizations are compartmentalized into relief and development units consistent with the conceptual framework that has ignored the linkages between disasters and development. Most international agencies are organized along relief/development or humanitarian assistance/development lines. The principals, modes, financing and procedural requirements of the two are separate and distinct. Technical and professional expertise often specializes in either relief or development careers, with little cross-fertilization between professionals who work in disasters and development. The separation is so complete that different organizational cultures have evolved (ECHO, 1995, USAID, 1996). While the relief culture is rapid response-oriented and flexible, which are desirable qualities; the planning frame is frequently in the order of days, weeks and months. Interventions rarely involve beneficiaries in planning, and there is little accountability for population level inputs and program efficiency. Development offices, while operating in a deliberate longer term planning frame, with explicit focus on population impacts and program sustainability, operate within inflexible bureaucratic planning and management frameworks.

There is a practical consideration also for better integration of development and relief work. In most situations that require rapid response to disasters, the organizations that are immediately present on the ground are the long-term development organizations. They are familiar with the country, region and the people and understand their needs. However, to the extent that long-term development and relief are divorced from each other these organizations have to respond to relief needs with one hand tied behind their backs. This disability can be removed by integrating relief and development in a smooth continuum.

Another constraint to the current organization of both donor and host country organizations is the compartmentalization of “sectors” within fairly narrow boundaries. Health offices are frequently charged with programming and implementing interventions to attack problems such as epidemic outbreaks and HIV/AIDS. These sectors frequently do not have sufficient analytical breadth and technical skills to address the behavioral determinants of these problems. There have, however, been many recent initiatives to merge offices that address human resource development problems.

Figure 12- Humanitarian Assistance to Sub-Saharan Africa

CPMR Approaches and Strategy

The new context of crisis in SSA demands fresh approaches by the development community. These approaches must take into account the changing face of crisis in Africa; the multiple immediate and underlying causes of crisis; the intimate relationship between disasters and underdevelopment; the importance of developing approaches that attack crisis at different stages, consistent with the current landscape in SSA; and approaches that engage Africans to take ownership of the programs for prevention, mitigation and transition from crisis to sustainable development. The approach, linking relief and development, has three objectives:

1. Improved design of long term development programs such that they prevent, or more successfully address, the short term contingencies faced by populations affected by chronic or recurrent disasters;

2. Improved short term disaster response interventions that are compatible with and maximize potential synergies with longer term development planning, and minimize potential distortions of the development process;

3. Improved transition strategies that reduce vulnerability to crisis and effectively leverage sustainable development as quickly and efficiently as possible.

A second element of the approach is that it must consider the ecology of crisis threats, rather than the usual country-driven approaches. This will require regional and cross boarder strategies, such as the Greater Horn of Africa Initiative (GHAI). Conflicts, natural hazards, HIV/AIDS and other infectious disease threats clearly know no boundaries. Effective strategies must embrace this reality.

Principles of Linking Relief and Development

Table 1 illustrates the chasm between traditional relief and development programming. In recent years, numerous expert and self-study groups have evolved towards consensus on ways to close the gap. Principles and operational approaches are emerging. The GHAI Task Force’s work to identify the principles for linking relief and development is illustrative.

First is the principle of local responsibility. Local ownership is key to the ultimate success of CPMR initiatives. Participatory assessment and planning is essential to correct past practices of top-down programs that assume affected populations to be passive recipients of relief (and sometimes development) interventions (Anderson, 1989).

Second is the principle of international responsibility in the areas of accountability and strategic coordination. All intervention efforts, including relief programs, must be held accountable for their population level impacts on survival and livelihood. This signals the need for an evaluation framework and suitable indicators that span the crisis life cycle, including prevention, mitigation, response and recovery/transition efforts. In addition, strategic coordination of international partners iskey. While coordination at the national level has improved in relief settings, much more must be done at the international level to ensure that collective and dwindling international resources are effectively used to address the needs of populations threatened by crisis.

Third, relief programs should be designed and operated such that they reinforce development objectives. This entails figuring in local participation, reinforcing existing capacities and building them, and protecting the livelihoods of affected populations.

Finally, development programs should be designed to help prevent or mitigate disasters such that development progress is not undermined. This can be achieved by more informed analysis of disaster and development linkages. Identifying the vulnerabilities of countries and particular population groups, designing programs to reduce vulnerabilities, and incorporating disaster preparedness into development programs is a first step towards this end. This has been demonstrated to be effective in recent history, particularly in southern Africa, but also in countries as poor as Niger.

Table 1 - Characteristics of Relief Planning and Longer Term Food Security Planning

Objectives	Relief Planning	Longer term food Security planning
General	Immediate relief for a population from inadequate access to food, and the threat of exess mortality	Longer term sustainable improvement in a population’s access to food, increasing self-reliance to reduce dependence on externally provided resources
Timescale	Short term, urgency	Long term, evolutionary

Approach to Planning and Implementation
Level of Planning	Centralized	Decentralized
Style	Top down, often hierarchical	Bottom up, participatory*
Management	Resource intensive, predominance of expatriate personnel	Resource extensive, emphasis on indigenous management
Information requirements	Specific information on relief need to direct immediate action – who and how much Emphasis on early availability of information.	Detailed information on food insecurity: types of food insecurity, who, and why cumulative process of information collection over time
Information collection	Rapid, often formal surveys carried out by visiting teams	Flexible systems of data collection usually emphasizing participation of target population
Role of target population	Passive	Active, particularly providing key resources **
Source of resources	Heavily donor dependent	Recipient government and local community contributions expected as well as resources provided by donors
Mobilization of resources	Rapid emergency procedures for releasing donor resources	Procedures for releasing funds (both by donors and recipient government) often require detailed and lengthy processes of appraisal and approval

Interventions
Type	Usually standardized, single tracked activity	Multidimensional, varied activities
Profile	High Profile	Low Profile

Winding-up of Donor Support
Process	Emphasis on rapid withdrawal of relief, often abrupt removal of donor supported structures and systems	Emphasis on handing over local management and funding, leaving systems in place*

*Indicates characteristics that are most difficult to achieve in practice

In order to effectively operate within this framework, however, international, regional, and national organizations will have to closely examine their own organizational constraints to effective CPMR. The GHAI study provides an illustrative example of the scope of reforms that will be needed. Table 2 presents the broad lines of these recommendations that include legislative, policy, administrative, procedural, and human resource development reforms.

Table 2– GHAI Task Force Recommendations for Addressing Agency Constraints to Linking Relief and Development (Source: USAID)

State-of the art knowledge developed and disseminated on the ways in which development programs can help prevent or mitigate crisis.

¨ Guidance developed and expanded on those factors associated with development programs that may increase the potential for violent conflict.

¨ Guidance developed and expanded on those non-conflict-associated factors that may increase the potential for causing crisis (e.g. epidemics, drought).

¨ Identifying key approaches for effective preventive diplomacy

¨ Identifying the key factors that make populations resilient to internal conflicts.

Promoting country and sub-regional policies and strategies for epidemic preparedness and response.

¨ Improved integrated disease control strategies and policies developed.

¨ Effective approaches for epidemic preparedness, early warning and response developed.

¨ Implementation/technical guidelines developed, adapted and tested.

¨ Tools for monitoring and rapid detection of drug resistance and epidemic progression developed.

State-of-the-art knowledge developed and disseminated on the issues that promote rapid transition from crisis to sustainable development.

¨ Guidance developed and expanded on the principles and approaches for linking relief and development.

¨ Guidance developed and expanded on the critical factors and conditions that are required for successful transition from crisis to sustainable development.

Assessment and evaluation approaches developed and promoted for application in crisis and transitional situations.

¨ Guidance developed and expanded on tools and methods that can be used for assessing trends, intervention costs, and program impact in crisis and transition situations.

¨ Guidance developed and expanded on program impact indicators or measures of effectiveness that are appropriate for use in crisis and transition situations.

¨ Building consensus on minimal information needed to monitor and evaluate current SSA crises. Including conflict, infectious disease threats, and population vulnerability.

¨ Building consensus on minimal indicators for evaluating emergency response and transition.

¨ Assessing the impact of disasters on USAID sustainable development countries.

More Effective and Efficient Regional and National Strategies to Address the Important Direct Crisis Threats to the Region

The most important crises facing SSA today include conflicts, epidemics (most notably HIV/AIDS), and natural hazards. While the international community has long recognized the importance of drought as a threat to African food security, there has been far less systematic treatment of other natural hazards, such as floods, and more importantly to the problems of conflict and epidemics. Each of these problems has been dealt with individually by the development community, when in fact, crises result from the antagonisms that are created when these problems affect the same populations.

While early warning and risk assessment strategies are relatively advanced for prediction of drought, these same techniques hold great promise for epidemic forecasting and for early identification of pernicious conflict. In the SSA context, integration of these types of information systems will improve the forecasting capability of these efforts while improving resource utilization by avoiding redundancy.

The problem of conflicts and complex emergencies requires a two-pronged strategy. In areas of the continent that have been recently affected by CEs, recovery/transition strategies are needed that recognize the unique needs of post conflict countries, including re-building civil society through programs that promote psychosocial well being as well as physical infrastructure building. The needs of post conflict societies are only now beginning to be understood and addressed. Much remains to be done in identifying best practices to facilitate rapid transition to sustainable development. In many cases, peace is fragile and the window of time available to promote transition may be short. Liberia, Rwanda, and the Democratic Republic of Congo are examples of countries that remain on the watch lists of the international community.

The second important element of a conflict strategy is early prevention and mitigation. Clearly, early warning and vulnerability or risk assessment is one key to improving readiness. However, another key element is through more effective engagement of African regional and national organizations in conflict management.

Finally, the international community must increasingly address crises through regional programs, such as the GHAI program, while at the same time recognizing the great diversity of community settings within crisis affected countries. Somalia provides perhaps the most dramatic example of a country where active conflict, instability and relative tranquility and prosperity are all occurring in the country. The World Health Organization (WHO) has supported some effective regional approaches to the prevention and mitigation of complex emergencies. Regional programs can prioritize resources to strategic initiatives that reduce the vulnerability of populations to the affects of war, for example, through a regional immunization initiative. Preventive diplomacy and transition programs that address the most critical causes of complex emergencies also may more effectively address the crisis context of SSA.

The Central Role of Public Health and Human Security

Even some of the most astute development economists have concluded that SSA must succeed in overcoming its health problems if the continent is to join the world economic order (Sachs et al, 1999). Using data from around the world, health (especially parasitic and infectious diseases) is an overwhelming constraint to African development. Malaria and HIV are perhaps the most important problems; however, infectious diseases aremore commonly prevalent and pernicious in the African setting than any other. The international community increasingly is coming to the realization that health improvements are vital to African development, as evidenced by recent trends in financing. Health is also central to facilitating a rapid transition from crisis to sustainable development.

It is not surprising that health is both an input to and a yardstick for measuring crisis. In SSA, disasters are generally defined in terms of excess mortality or malnutrition (i.e., crude mortality in excess of 1/10000/day, or acute undernutrition levels in excess of 15%). Unhealthy populations are more susceptible to external shocks, and these shocks most commonly cause excess mortality through morbidity and malnutrition. In this way, unhealthy populations are particularly vulnerable to the immediate hazards associated with drought, epidemics and conflicts.

Much can be done to improve the capability of Africans to survive these types of shocks by investing in basic preventive interventions, especially those that reinforce the capability of Africans to care for themselves and their families. Immunization and basic communications programs to promote early exclusive breastfeeding, family management of infectious diseases and STD/HIV prevention are low cost interventions that could prevent significant mortality in the event of a crisis threat.

Health initiatives also can leverage the development of civil society. Health is a cause that everyone rallies around and it is rarely seen as a competitive domain of interest. Public health programs provide an excellent vehicle for demobilization and the re-establishment of trust between former military and civilian populations. Military can be employed successfully to provide immunization and the construction of basic health infrastructure.

Other innovative strategies include the engagement of the military in combating HIV/AIDS. As the military has represented a core group facilitating the spread of the epidemic, their engagement in HIV/AIDS prevention is crucial. USAID and the other organizations have funded a very successful pan African military alliance for HIV/AIDS prevention, the Civil Military Alliance (CMA). This network provides an opportunity to expand similar strategies for involving the military in civil society projects.

Finally, dramatic health sector reform is frequently a rare opportunity in the post conflict (recovery/transition) environment. In the post conflict setting, both the physical and the human health infrastructure have been destroyed or damaged. While the task of rebuilding this infrastructure may seem daunting, the opportunity to developed effective preventive care-oriented health systems is enormous. Systems can be designed and implemented according to current international best practices without having to address the policy and bureaucratic constraints of expensive, ineffective and inequitable systems of many developing countries.

More recently, the concept of human security has been developed as an overarching framework for understanding the range of threats to health and well-being. The international community is increasingly convinced of the relevance of this framework to crisis prevention, mitigation and recovery. Human Security is defined by the United Nations (UNDP, 1994) as “it means, first, safety from such chronic threats of hunger, disease and repression. And second, it means protection from sudden and hurtful disruption in the patterns of daily life, whether in homes, in jobs or in communities”. Human security provides a conceptual framework for linking the determinants of crisisand development. Current efforts are being made to operationalize the concept in order to identify the programmatic implications for crisis prevention, mitigation and recovery.

Performance Monitoring of Interventions Across the Crisis Life Cycle is Critical

While traditional development programs have relatively sophisticated evaluation frameworks and indicators for determining impact and efficiency, crisis interventions are rarely subjected to such systematic scrutiny. For example, one of the most comprehensive data bases on refugee health and nutritional status, including observations for hundreds of refugee camps, reports population-level health-related information was only available about 10% of the time (ACC/SCN, 1994).

Elaborating such a framework, for the different phases of a crisis life cycle, is the first step in developing evaluative criteria or measures of effectiveness. During the Somalia crisis, the American military were particularly struck by the lack of clear performance objectives. They initiated an interagency analytical exercise to develop the framework and indicators. The preliminary results of this exercise are illustrated in Table 3.

Table 3- Suggested Measures of Response Effectiveness for CEs (Source: USAID)

1. Security and levels of violence

· number of violent acts against each distribution center

· number of violent acts against convoys

· fraction of inventory stolen from distribution centers

· fraction of inventory stolen from convoys along each key distribution route

· fraction of security for the distribution center assumed by the host nation or international agency security guards

· fraction of security for the convoy taken over by the host nation or international agency

2. Infrastructure

· fraction of visual flight rules (VFR)-day capable airfields, by aircraft type

· fraction of all key transportation routes that are convoy suitable

· fraction of infrastructure repair effort met by host nation or international agencies

· fraction of potable water sources re-established

3. Medical and public health issues

· crude mortality rates

· under 5 mortality rates

· cause-specific mortality rates

· levels of severe malnutrition

4. Agricultural and economic issues

· market price of staple foods

· market price of animals

· fraction of land cultivated or used for animal husbandry

· household food security

Systematic Mechanisms for Identifying Information Gaps and Disseminating Best Practices

CPMR is a cross-cutting analytical domain for policy research and programming strategies. As such, there are many gaps in our understanding of how to effectively address crisis threats. It is critical that mechanisms be established for systematically identifying knowledge gaps, best practices, and dissemination of new information. Much conceptual, analytical and consensus building is left to move this objective forward. Table 4 contains an illustrative list of work to be done as identified by the international CPMR network co-sponsored by USAID, several American and European academic institutions, and representatives of the PVO community.

Table 4- Areas Where Further Analysis Research is Needed