Identifying priority healthcare trainings in frozen conflict situations: The case of Nagorno Karabagh.

Michael E Thompson,Alina H Dorian,Tsovinar L Harutyunyan

doi:10.1186/1752-1505-4-21

Abstract

IntroductionHealth care in post-war situations, where the system's human and fixed capital are depleted, is challenging. The addition of a frozen conflict situation, where international recognition of boundaries and authorities are lacking, introduces further complexities.Case descriptionNagorno Karabagh (NK) is an ethnically Armenian territory locked within post-Soviet Azerbaijan and one such frozen conflict situation. This article highlights the use of evidence-based practice and community engagement to determine priority areas for health care training in NK. Drawing on the precepts of APEXPH (Assessment Protocol for Excellence in Public Health) and MAPP (Mobilizing for Action through Planning and Partnerships), this first-of-its-kind assessment in NK relied on in-depth interviews and focus group discussions supplemented with expert assessments and field observations. Training options were evaluated against a series of ethical and pragmatic principles.Discussion and EvaluationA unique factor among the ethical and pragmatic considerations when prioritizing among alternatives was NK's ambiguous political status and consequent sponsor constraints. Training priorities differed across the region and by type of provider, but consensus prioritization emerged for first aid, clinical Integrated Management of Childhood Illnesses, and Adult Disease Management. These priorities were then incorporated into the training programs funded by the sponsor.ConclusionsProgramming responsive to both the evidence-base and stakeholder priorities is always desirable and provides a foundation for long-term planning and response. In frozen conflict, low resource settings, such an approach is critical to balancing the community's immediate humanitarian needs with sponsor concerns and constraints.

Highlights

Health care in post-war situations, where the system’s human and fixed capital are depleted, is challenging
Training priorities differed across the region and by type of provider, but consensus prioritization emerged for first aid, clinical Integrated Management of Childhood Illnesses, and Adult Disease Management
Within the realm of humanitarian assistance, the evidence on how to respond to disasters has evolved: Public health specialists and Non-governmental Organizations (NGOs) have developed protocols for preparing for and managing responses to earthquakes, cyclones, natural disasters, and, sadly, endemic wars [1,2,3,4] and evidence is emerging on how best to transition from humanitarian response to development [5,6]

Summary

Introduction

Health care in post-war situations, where the system’s human and fixed capital are depleted, is challenging. Case description: Nagorno Karabagh (NK) is an ethnically Armenian territory locked within post-Soviet Azerbaijan and one such frozen conflict situation. This article highlights the use of evidence-based practice and community engagement to determine priority areas for health care training in NK. Evidence-based approaches in public health practice provide a systematic, objective framework that can inform policy and decision-making by establishing priorities that make maximal use of limited resources. The cease-fire has held, a permanent peace has not been negotiated: the conflict has been “frozen,” with little progress made in the past 15 years despite intensive efforts by the international community to foment a peace process. NK is not internationally recognized as an independent nation [9]

Results

Discussion

Conclusion