Diplomatic and operational adaptations to global health programmes in post-conflict settings: contributions of monitoring and evaluation systems to health sector development and ‘nation-building’ in South Sudan

Abstract

Monitoring and evaluation (M&E) systems are an essential element of functioning and accountable global health programmes. In post-conflict settings, the role of M&E systems is also critical to ensure that health services are being delivered to those populations and regions most in need. Given the inherent challenges of health service delivery in such environments, a range of both diplomatic and operational adaptations to M&E procedures are necessary. Using the '12 components' of a functioning M&E system as a conceptual and analytical framework, we observed and reviewed the key challenges to M&E systems in South Sudan as part of a broader review of United Nations Development Programme (UNDP) activities supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Based on additional interview-based reviews and analyses of M&E activities, a list of adaptations to standardized M&E procedures in response to post-conflict environmental challenges was developed. The study concludes that development and implementation of M&E systems in post-conflict environments requires extensive adaptations to conventional procedures. Flexible and adaptable as well as 'diplomatically sensitized' M&E systems are considered to be essential to the successful completion of M&E-related activities, and may also contribute to broader international relations, 'nation-building', and peace-keeping goals.

Global Health Diplomacy, ‘Smart Power’, and the New World Order

“…1 Neutrality: The selection of culturally, religiously and socially appropriate interventions (Kevany, 2012;Kevany, Hatfield, et al, 2012;Kevany, Khumalo-Sakutukwa, et al, 2012), encompassing vigilance around possible unanticipated consequences of global health programmes on recipient societies, cultures and religions (Adams, Novotny, & Leslie, 2008) 2 Visibility: Appropriate programmatic branding to generate positive associations between international presence, health outcomes, and donor prestige (Alesina & Dollar, 1998), thereby ensuring that (1) …”

“…Recent examples of Africa Union forces operating in collaboration with global health initiatives in Somalia have shown how compelling such collaborations can be in combating political and religious extremism, illegitimate regimes, and tyranny (see, e.g. Straziuso, 2013), in the manner of successfully coordinated efforts between the United Nations' armed missions and the United Nations Development Program in South Sudan (Kevany, Hatfield, et al, 2012).…”

“…This experience includes examination of the international relations effects of Global Fund-supported malaria programmes in Afghanistan and Iraq (Kevany, Jaf, et al, 2014;Kevany, Sahak, et al, 2014); the development of 'diplomatically-sensitised' monitoring and evaluation systems in South Sudan (Kevany, Hatfield, et al, 2012), the implementation of transferable and sustainable innovative antiretroviral adherence programmes in Ethiopia (Marseille & Kevany, 2010); the responsiveness and adaptability of voluntary counselling and testing services to prevailing political, social and economic conditions in Zimbabwe (Kevany, Khumalo-Sakutukwa, 2012;Kevany et al, 2013) and the alignment of global health programmes with diplomatic priorities (Fleischer, Kevany, & Benatar, 2010) in South Africa .…”

Global health diplomacy, national integration, and regional development through the monitoring and evaluation of HIV/ AIDS programs in Papua New Guinea, Vanuatu, and Samoa

“…Efforts made in the design, delivery and M&E of HIV/AIDS programs in Vanuatu have successfully adapted to this dual role of simultaneously promoting health and well-being whilst also contributing to the development of a national identity in a fashion that has been documented in other contexts (3). The national government has leveraged a range of opportunities to advance national integration, regional cooperation, and public health in concert with each other (13) -not just through the provision of health services, but also in parallel with culturally-appropriate health and education campaigns (14); inter-island supply chain and M&E activities; and joint national and regional training initiatives that focus on the application of M&E-driven decision-making in a coordinated and harmonious fashion within and across Secretariat of the Pacific Community (SPC) member countries (15).…”

James Bond and Global Health Diplomacy

“…20 The advancement of foreign policy goals by national governments through health and development programs is, thus, a natural evolution of this association. Actors such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM), the President's Emergency Plan for AIDS Relief (PEPFAR), and the United Nations Development Program (UNDP) frequently (though on an ad-hoc basis) advance both health and non-health agendas in unison, such as the secession of South Sudan from the Republic of Sudan, 21 challenging extremism in Afghanistan, 22 or contributing to conflict resolution in Iraq. 23 Even players such as Medicins sans Frontieres (MSF) and the World Health Organization (WHO), despite their exclusively apolitical manifestoes, cannot hope to avoid some form of non-health influence, partisanship, or even (in the case of MSF) potentially offensive elitism.…”