Advancing the science for health programming in crisis conditions

Humanitarian crises are becoming increasingly complex and a growing threat to the health and safety of populations. An improved evidence-base to guide interventions in the countries most vulnerable to these conditions is more critical than ever. A paper by researchers at Columbia University's Mailman School of Public Health published online in the journal Science, looks at the challenges of doing research in such settings and the strategies that must be adopted for scientific advance.

"The circumstances of humanitarian crises present many barriers to the conduct of scientifically rigorous research, and yet it is these same circumstances that make a solid evidence base so crucial for health programming in these settings," said Alastair Ager, PhD, professor of Population and Family Health.

While there have been notable advances in immunization programs and treatment of acute malnutrition over the years, the evidence base for many other current practices remains weak. Lack of data constrains ongoing research. Even when relevant data are present, the breakdown of health information systems and displacement of populations can often mean there is little access to the data. In cases where data is accessible, there is often a lack of incentive for the sharing of information.

The process of bringing together researchers and program managers from academia and humanitarian organizations across continents for a new research funding initative led to formulating the five following themes for scientific advancement, all critical to progress in the field of humanitarian response:

• Better use of evidence from non-humanitarian settings
• Development of robust methodologies appropriate to crisis settings
• Identifying ethical bases for considering the consequences for those not receiving a particular intervention
• Engaging local participation to ensure cultural adaptation and that specific demands of a humanitarian context are addressed with a contextual sensitivity
• Establishing effective engagement with research institutions from low- and middle-income countries to making data available to as broad a community as possible

"Although many health risks in the aftermath of disasters or conflict are predictable and minimum best practice interventions have already been established, health needs can evolve rapidly, and we must be ready with adaptable program strategies," said Ager.