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Actors: roles, perceptions, agendas

Table of contents Contents Introduction The policy making environment Reviewing stated policies Matching stated policies to field realities Policy contents and allocative patterns Features of strong policy proposals Sustainability of chosen policies Looking at some concrete examples of policy implementation Actors: roles, perceptions, agendas Government (central and peripheral) Rebel groups Transitional (UN) authorities, UN agencies Development banks Donors The European Humanitarian Aid Office (ECHO) Non-Governmental Organisations (NGOs) New actors in the humanitarian field, Professional associations Understanding Coordination Recommended Reading References Annex 5a: Establishing a Policy Intelligence Unit Annex 5b: Sector-Wide Approaches in Disrupted Health Sectors

The perceptions of actors tend to aggregate around two extreme patterns. To insiders, the crisis is unique and emotionally charged. It is “their” crisis. Damage control is often the dominant concern. Solutions have to be found domestically, by patient experimentation. Lessons learned from abroad tend to be ignored or even outrightly rejected. The opposite approach is typical of newcomers belonging to international networks. They may arrive from other disrupted countries, bringing in, with the experience gained elsewhere, associated prejudices. What has worked in the previous crisis is aggressively replicated in the new settings. When contexts are radically different (an assessment which is by definition difficult to make for both insiders and outsiders), serious mistakes follow. In their pure form, both perceptions are likely to result fallacious. As crises use to show recurrent as well as original patterns, successful approaches often arise from a balance of sensitivity to context and international experience. To recognize variety as a common pattern of chronically disrupted contexts is a precondition to understanding.

Some indigenous actors may have developed a particular state of mind, shaped by the vision of an idealised pre-crisis past, when the health sector was supposedly performing well and proceeding firmly in its development. In this view, any possible problem presently affecting the sector is the unquestioned result of the disruption. Some of these individuals may have occupied important positions and lost them. Sometimes, they have lived abroad during long periods. Detached from the developments taking place in the country and the sector, they may have elaborated visions and plans based on that idealised past, which the crisis ‘stole’ from them. These plans may be tabled during a transitional period, when the future of the sector is under discussion, and can become very popular among local cadres, because they respond in some way to the need, felt by every victim, of minimising the pain inflicted by the crisis. The product of these elaborations may be rather elegant, given the way they have been built, i.e. unimpeded by real-life hurdles. A capacity constraint, for instance, is rarely referred to, nor is the meagre financing base likely to condition sector recovery.

Documented experience in different countries shows a recurrent pattern, as development partners change role over time. During the emergency period, NGO’s are usually the main channel of support to health service delivery and coverage is uneven. As the situation gradually stabilizes, the new government establishes itself, assumes responsibility and sets up recurrent budgets. During reconstruction, major donors and development banks provide sources of investment capital. Later, bilateral donors can move to the direct financing of state budgets.

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