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Beyond the ‘Egosystem’: A case for locally led Humanitarian Resistance

This article invites readers to consider a new form of humanitarianism that has emerged out of people’s resistance to military atrocities—called Resistance Humanitarianism—with a particular focus on the crisis in Myanmar. In that country, Resistance Humanitarians are challenging traditional aid actors because their operational presence and coverage can go deep inside the hardest-hit areas, which are usually inaccessible to the large INGOs and UN. This gives Resistance Humanitarians significant operational advantages, particularly the acceptance of the population, access, and data that reflects ground realities. Meanwhile, most international aid actors continue to try and gain access to affected communities through Myanmar’s oppressive and illegitimate military junta, constraining their ability to reach those most affected by crisis and potentially aiding the junta’s violent cause. The paper suggests that this vertical, top-down, ‘neutral’ approach to aid access taken by many international actors may deepen the conflict, as it pushes people away from their determination for a systematic end to injustice. The paper also argues for the urgent need to critically rethink the humanitarian approach for the Myanmar conflict, and suggests a new type of aid architecture—a locally-led, horizontally-constructed ecosystem that builds on and supports people and organisations on the ground and prioritises inclusivity, diversity and collaboration at its heart. If the aim of external international actors is to build resilience, they must rethink their approach and support military-avoiding Resistance Humanitarianism.

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The role of local government in tackling a global pandemic: A lesson from Nepal

This paper critically analyses the scope of leadership in Nepal at the local government level when tackling the wider impacts of COVID-19, with a particular focus on health service delivery in line with World Health Organisation (WHO) frameworks. In-depth interviews with 66 representatives from local governments (LG) in the Madhesh and Sudurpaschim provinces were conducted, along with analysis of routine data from health management information systems. We found that Maternal Child Health (MCH) services at local health institutions were largely unimpacted, stocks of essential medicine were available, and the LGs exhibited determination and capability in getting to grips with the crisis, despite inadequate knowledge and resources. Nevertheless, there was sizeable shrinkage in the utilisation of services, which triggered public health concerns of a different nature, the LGs were inadequately prepared in regards to the capacity and availability of human resources, and there were explicit gaps in terms of coordination among all three tiers of government and a lack of role clarity that delayed the response to the pandemic at the local level. Our recommendations include continued investment in local MCH services, capacity building for local leaders with a focus on human resource management in emergency contexts, and the simplification of public procurement processes, particularly during crises, enabling LGs and other local actors to expediate procurement and improve response times.

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Bayanihan E-Konsulta: A volunteer-driven response to the COVID-19 pandemic in the Philippines

COVID-19 stretched health systems worldwide, but its deepest impacts were disproportionately felt across certain population segments. In the Philippines, a low-middle income country with one of the longest pandemic-induced lockdowns, the most marginalised communities suffered the most, and had little agency to afford and access care. Socioeconomic barriers, compounded by the misallocation of limited resources and the militarisation and overall mismanagement of the response, widened inequities, and resulted in poorer health outcomes for these groups. In an attempt to redress this, the Office of the Vice President of the Philippines sought to fill gaps in health delivery and access by launching Bayanihan E-Konsulta (BEK), a free telemedicine platform for indigent Filipinos. Through a Facebook messenger service that ran on free data, patients were given the opportunity to consult with health professionals regarding their medical concerns at no cost. Relevant social services, such as prescription delivery, laboratory assistance, and food and financial aid, were also streamlined in the platform. Recognising limitations in funding, the program banked on the mobilisation of health professionals and volunteers, and relied on capacity building initiatives and the establishment of inter-agency collaborations. Institutional credibility, intersectoral collaboration, and effective management of team dynamics were identified as enabling factors for the program's effectiveness. Transparency attracted partnerships, and trust in leadership inspired solidarity, volunteerism, and continued service. Inclusivity in different project stages improved engagement and encouraged shared participation and accountability, allowing for resilience and sustained action. Overall, BEK stands as a successful example of a low-cost public/private/volunteer health response in a time of crisis. This paper discusses the critical challenges, considerations, and the iterations to the service implemented by the BEK team, providing insights for public health leaders and other low-to-middle income countries when tailoring responses to future public health emergencies.

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