3.4. Challenges in reconstruction

  • Share

Reconstruction is extremely complex, from a political, strategic, and funding standpoint. The time it takes to execute reconstruction works poses serious challenges for the health sector, including the following:

  • The necessary financial resources to implement programs. Many countries exhaust their available resources during the emergency phase FOR response activities.
  • Health must compete with other priorities; government officials often give greater priority to strategic and production sectors.
  • Humanitarian aid agencies are not so disposed to providing assistance in the reconstruction phase, because the their mandates place priority on saving lives or responding to the immediate emergency.
  • Multilateral funding agencies such as the World Bank, the Inter-American Development Bank, and the European Union require well-developed plans and usually focus on investment projects in production sector. Resources are generally not available immediately.
  • Health sector reconstruction projects often are unable to take advantage of windows of opportunity to improve the care model. Rebuilding damaged facilities or building new hospitals can be a political decision because these it is more visible and politically profitable.
  • In many cases, there is frequent turnover among staff at the decision-making level, which can affect long-term reconstruction planning and implementation.
  • The population of the community affected by a disaster usually has little or no role in planning for reconstruction and not enough study is devoted to decisions on the size and complexity of the health facilities to be built.
  • The application of construction norms and standards requires strict supervision as well as direction from multidisciplinary technical teams. Unfortunately, however, this important task tends to get pushed aside because of the time pressures involved in reconstruction.
  • Field working groups are required to ensure sustained oversight.
  • Managing reconstruction projects in the health sector requires professionals with broad experience and knowledge of the country’s health system. The improvised selection of management or technical project staff can lead to errors in management and results.
  • Handle expectations regarding the results of rehabilitation properly, drawing on the notion of ‘building back smarter’.