Public health and humanitarian interventions: developing the evidence base

During an emergency response, there is a tension between saving lives in the short term and promoting longer-lasting health systems development. An article in the British Medical Journal makes the case for expanding the evidence base underlying humanitarian aid. Policies and practices based on the best available evidence are essential to maximising the value of available resources in relief situations.

The article builds on current debates about evidence-based medicine and policy. It describes health threats in conflict situations and the lack of good evidence underlying relief programmes. A better evidence base would enable aid agencies to be more accountable and provide greater value for money, it argues. It outlines approaches for gathering evidence in emergencies and some difficulties involved in this. It concludes with suggestions for encouraging the use of evidence-based practice.

Populations affected by armed conflict suffer severe public health problems due to food insecurity, displacement, injuries and the collapse of basic health services. But there are many logistical, safety and practical obstacles to research during wars and political violence. It is also difficult to promote good practice in the emergency aid sector due to rapid staff turnover, time pressures and scarce resources.

The paper identifies research needs in several key areas:

• nutrition:food security, caring capacity of households and communities, micronutrients, feeding programmes
• reproductive and women’s health:violence, basic care, sexually-transmitted infections, reproductive health services
• communicable diseases:water supplies, cholera, malaria, acute respiratory infections, gender considerations
• health service management:resource mobilisation, organisation, evaluation and impact assessment
• information management:data collection, analysis, use and interpretation, including new technologies
• mental health:assessment, service delivery, violence

The authors make the following recommendations:

• research to identify effective and efficient approaches to the delivery of aid deserves more investment. This will require collaboration between aid agencies, academics and donors
• relief programmes should be based on the most up to date and valid knowledge base, use more rigorously trained professionals and assure earlier and more effective programme planning and co-ordination
• researchers should adopt an ethical approach that maximises benefit and minimises harm, requires informed consent, ensures confidentiality and treats individuals with appropriate clinical care and dignity
• there should be explicit incentives to reward lesson learning and development of good practice
• donors should encourage good practice by rewarding organisations willing to admit their failures and correct their mistakes