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Rehabilitating health services in Cambodia: the challenge of coordination in chronic political emergencies.

Abstract：

:The end of the Cold War brought with it opportunities to resolve a number of conflicts around the world, including those in Angola, Cambodia, El Salvador and Mozambique. International political efforts to negotiate peace in these countries were accompanied by significant aid programmes ostensibly designed to redress the worst effects of conflict and to contribute to the consolidation of peace. Such periods of political transition, and associated aid inflows, constitute an opportunity to improve health services in countries whose health indicators have been among the worst in the world and where access to basic health services is significantly diminished by war. This paper analyzes the particular constraints to effective coordination of health sector aid in situations of 'post'-conflict transition. These include: the uncertain legitimacy and competence of state structures; donor choice of implementing channels; and actions by national and international political actors which served to undermine coordination mechanisms in order to further their respective agendas. These obstacles hindered efforts by health professionals to establish an effective coordination regime, for example, through NGO mapping and the establishment of aid coordinating committees at national and provincial levels. These technical measures were unable to address the basic constitutional question of who had the authority to determine the distribution of scarce resources during a period of transition in political authority. The peculiar difficulties of establishing effective coordination mechanisms are important to address if the long-term effectiveness of rehabilitation aid is to be enhanced. :This paper analyzes the context and process of health aid coordination in Cambodia between 1991 and 1993. It emphasizes on the relationship between national political actors and several international agencies that came to work in the country during that period. It also complements the experiences faced by Cambodia in this period and features two key issues. First, the political factors affecting the type of aid supplied to the country, and the way it was governed in the period during 1991-93. These structural, political factors constrained the scope for the health profession to build effective coordination mechanisms. Second, the limited capacity of coordination mechanisms to influence resource allocation did not correspond to the national health priorities. Overcoming the hardships will be dependent on using more organized strategies and appropriate aid instruments to support rehabilitation measures. And lastly, an evaluation of the implications for the other post-conflict settings was briefly discussed.

journal_name

Health Policy Plan

journal_title

Health policy and planning

authors

Lanjouw S,Macrae J,Zwi AB

doi

10.1093/heapol/14.3.229

subject

Has Abstract

pub_date

1999-09-01 00:00:00

pages

229-42

issue

eissn

0268-1080

issn

1460-2237

journal_volume

pub_type

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Rehabilitating health services in Cambodia: the challenge of coordination in chronic political emergencies.