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Ahead of the Curve: Providing Sustainable Health and Education Services in Disaster Recovery Programs
Research shows that quick revival of social infrastructure such as schools and hospitals can fast-track the return to normalcy, facilitate restoration of economic activities, and increase the resilience to cope with future disasters. Learn how this can be done.
Approaching Reconstruction and Rehabilitation
Efficient and effective reconstruction and rehabilitation of education and health facilities can be achieved through coordinated strategy that ensures clear policy and planning parameters; implementation arrangements that build local ownership and capacities with strong oversight and accountability; technology and procurement options that are quick, safe, transparently delivered, and adapted to local capacities, material, and knowledge; and operations and systems to provide sustained quality services.
The reconstruction phase typically involves a trajectory of returning to "normality." This includes the implementation of capital projects (housing, schools, clinics), reestablishment of basic public services in a sustainable manner, and "replacement/rebuilding of the human resource base," i.e., in the case of the 2005 Pakistan earthquake, many teachers and health staff perished.
The health and education sectors exemplify the difficulties created by enforcing the unnecessary divisions between the relief, early recovery, and reconstruction phases. The failure to see these three stages as a continuum introduces planning disconnects and system inefficiencies. Reconstructing these social infrastructure require critical approaches to planning, implementation, and sustainable service delivery.
Planning the Return to Normalcy
Post-disaster needs assessments have been generally effective in informing overarching policy and sector strategies in health and education, but much less effective in detailed sector planning for reconstruction, unless they are supported by continuing assessments. In the case of the Pakistan earthquake, no primary assessment of the education and health damages and existing capacities was undertaken, which resulted in poor planning and delays in reconstruction. Where primary assessment is undertaken with existing capacities and limitations in mind, a much more effective reconstruction policy is formulated that integrates sustainability of health and education services at the outset.
Reconstruction policy is needed to ensure standards for safety (to build back better), right sizing (building to relevant standards), right siting (relocation, land use, and master planning), rationalization (prioritizing), roles (key agency responsible), sustainability (resources for ongoing operation), and equity. In the Pakistan earthquake, the lack of such policy resulted in major delays, use of differential standards, and lack of resources and staff for running completed facilities.
Comprehensive strategy lays the foundation for planning by defining the scope of activities; prioritization criteria for subprojects; approval and oversight mechanisms; technological options for reconstruction; the procurement approach and role of agencies and local communities in planning and oversight; additional staffing requirements; risk mitigation related to disaster, environmental and social safeguards and good governance; and monitoring and evaluation. Key components of the strategy adopted by the Government of Pakistan after the 2005 earthquake included:
- Strategic integration of smaller health units into larger facilities;
- Closure or relocation of health facilities, if no longer justified; and
- Upgrading of facilities to reflect current population size
Implementation Arrangements and Delivery of Infrastructure
Enhanced fiduciary safeguards and risk mitigation measures, including internal controls and external audits, third-party (including beneficiary and other public) monitoring, and independent oversight and disclosure are key accountability measures for successful post-disaster reconstruction.
Institutionalizing fast-tracking through emergency procedures is necessary for expediency, although experience suggests that in most cases, these have not been institutionalized, are usually re-invented, and staff have to be trained in their use every time there is a disaster. Given the frequency of disasters, there is dire need to institutionalize emergency procedures and systems, especially in agencies responsible for reconstruction.
Capacitating the organizational setup: For effective reconstruction, a main challenge has been the additional human resource requirement in the short to medium term, retention and additional load on existing staff, and the need for capacity building. It took more than one year after the earthquake in Pakistan to get additional human resources placed in the organizations responsible for health and education sector reconstruction. For efficient recovery, the focus should be on staff and institutional incentives, outsourcing to the private sector and NGOs, and targeted capacity building.
Smarter design: The Hyogo Framework for Action has introduced the concept of safe schools and hospitals to address disaster risk in the design of education and health facilities. However, design practices in most countries have not fully adopted these guidelines in their standards, and their application is often weak due to capacity issues and varying quality in construction practices. More attention in the form of capacity development, training, and improved standards for reconstruction are needed to ensure community services remain accessible and functioning at maximum capacity when disaster strikes.
Procurement officials in both government and non-government agencies are expected to exercise high levels of competence, discretion, and integrity, but in many cases lack adequate training and experience of procurement in emergencies, are influenced by local political forces, and have limited understanding of the supply side constraints. While ex-ante controls on procurement must give way somewhat to the urgency of recovery and reconstruction, this must be compensated by tighter ex-post inspection and auditing.
Towards Sustainable Service Delivery
Improved sustainability and service delivery of the reconstructed facilities: Throughout project design and implementation, it is essential that local stakeholders are actively involved in all stages of the reconstruction cycle. Likewise, reconstruction activities should be undertaken through them to the extent possible. This allows technology transfer, ownership, and building of local capacities to construct and maintain infrastructure built to multi-hazard-resistant standards. A sustainable and successful project goes beyond site selection, the choice of a sustainable solution, and training of local builders; it also involves issues of land tenure, finance, education for risk awareness, and future maintenance.
Locally adapted designs empower communities and local institutions: Existing conventional or local construction techniques and materials allow use of readily available expertise and material and the possibility to deliver through local institutions, contractors, or communities themselves. This allows for much needed local employment and economic opportunities, more ownership, and cost-effective maintenance later. Community-driven development approaches have proven very flexible in supporting local solutions.
Integrating reconstruction with development planning for sustainable services: Similarly, handing the existing development deficits and sustainability issues of reconstructed infrastructure remains a challenge in post disaster situations. The reconstruction plans should be coordinated and integrated with development plans, so that support for endemic reforms and sustainability challenges in health and education can get embedded and are addressed in the regular development planning.
Getting the Right Tools and Stakeholders Involved
ADB and other development organizations have developed an improved set of tools for guiding and supporting post-disaster reconstruction. Track records on using local resources (technical, financial, operational), technology transfer, local capacities and preparedness, and community and stakeholder involvement are improving steadily among development organizations. The capacity development programs during recent disaster responses in Pakistan, China, Indonesia, and Sri Lanka have included academia, professional associations, line departments, and licensing bodies. This ensures that architects, engineers, and builders are involved in upgrading and correctly applying the appropriate codes and construction techniques plus have the internal capacity to maintain the completed infrastructure. For example, under the Earthquake Relief and Rehabilitation Project in Pakistan, communities were put in charge of identification, construction, and oversight of schools and health facilities projects through participation in School and Health Management Committees, which created community ownership and maintenance of these services.
The value of ownership and sustained capacity to build back better cannot be understated. Better use should be made of local resources, including technology transfer, mechanisms of local participation and capacity building in planning, reconstruction, operations, and preparedness. Sustainability can also be ensured by managing unsustainable expectations by setting transparent policy parameters and reconstruction standards at the outset. The main challenge for sustainability has been and still remains the funding for maintenance and operations, and the lack of capacities to operate the completed health and education facilities in the public sector according to necessary service levels and safety standards. Expectations for sustainability must be negotiated and addressed in policy and sector strategies, both pre-disaster and at the outset of any disaster event, and reinforced through capacity development which also requires government commitment, resources, and active monitoring throughout the reconstruction process, apart from integrating the longer term reform measures required in the regular planning process of host countries.