Responding to HIV and health in fragile states

More than half of the people living with HIV live in fragile states. The Alliance and the International Federation of Red Cross and Red Crescent Societies (IFRC) embarked on a new partnership in 2014 to build community capacity to respond to HIV and wider health issues in these countries.

Following conflicts and natural disasters*, health systems are weak or are quick to collapse as health workers flee, and supplies and equipment run out. Preventable diseases increase alongside malnutrition, and even where health services do exist people are too afraid to risk the journey to the clinic. Half of all under-five deaths and one-third of maternal deaths occur in fragile states.**

Haiti camp outreachOutreach work in temporary camps following the earthquake in Haiti © Alliance

In these challenging situations, the international community is heavily focused on the humanitarian crisis with little attention given to HIV and the sexual and reproductive health challenges. Ignoring these issues can have a detrimental impact on the health of people living with HIV and can contribute to worsen the HIV situation among internally displaced people and other crisis affected populations.

Collective experience

The partnership between the Alliance and IFRC will leverage our extensive experience and service delivery platforms in humanitarian responses. Together, we will develop sustainable community models for delivering access to HIV testing and treatment and to improve health outcomes in fragile states.

This model will require a long-term investment into building strong and well-functioning local civil society organisations, including Alliance Linking Organisations, National Red Cross and Red Crescent Societies.

“The IFRC is committed to harnessing locally-led responses and strengthening community involvement with health service delivery” said Bekele Geleta, Secretary General, IFRC. “Through our volunteer network and community-based platform for health service delivery, National Red Cross and Red Crescent Societies are strengthening community health systems. This partnership will contribute towards supporting essential community resources in critical situations.”

Integrating HIV and humanitarian responses

A shortage of healthcare workers in fragile states means it is essential to build the capacity of community resources. Health workers, volunteers and community leaders are the right people to deliver crucial, culturally sensitive health messages.

Alvaro Bermejo, Alliance Executive Director, said, “Civil society organisations have local expertise, on-the-ground agility and established networks and can adapt to the changing circumstances.
“We will be working to link local organisations and networks, including networks of people living with HIV, to national and local disaster preparedness training and systems so they are fully equipped to respond to the needs of communities in fragile states.”

The two organisations will also be working with donors and partners who need to be able to react quicker and provide more immediate and flexible funding channels to enable civil society and other stakeholders to carry out a better-coordinated response.

To mark the start of the partnership, the Alliance and the IFRC jointly hosted (in partnership with the Islamic Republic of Afghanistan) a side event at the 67th World Health Assembly in Geneva entitled ‘Fragile states: boosting community systems for an effective health response’.

Case studies

These three case studies examine the experience of three Alliance Linking organisations working in fragile states:

  • The HIV response in political conflicts: Lessons learnt from Cote d’Ivoire 2002-2010
  • The HIV response in emergencies: Lessons learnt from the 2010 Haiti earthquake
  • The HIV response in conflict: Lessons learnt from South Sudan

You can read the case studies here.

*Conflicts and disasters alone are not the only reason for state fragility. States can also be fragile due to lack of growth or chronic underperformance. Increased exposure to disease and high mortality rates can be both a contributing cause and consequence of state fragility.

**A fragile state is one where there is a fundamental failure of the state to perform functions necessary to meet the basic needs and expectations of its citizens.