September 25


Health in Complex Settings

Already 2 ½ months in my home assignment in Geneva at International Federation of Red Cross and Red Crescent (IFRC)…

It’s time to start blogging!!!

Where am I – What are the objectives – What can I deliver ???

These are the 3 questions that kept me awake several nights in July/August, as it was so unclear/unspecified, so different environment, different people and way of working than what I know at GSK.

But now, for a couple of weeks, more or less from September when all people are back from summer vacation (and paternity leave for my supervisor, yeah), when projects a bit sleeping are reactivated because of time pressure, also after we know better each other and understand roles, responsibilities and skills (especially soft skills) of individuals (incl. mines :)), now things are almost/very clear ahah, now I will start to awake not because of uncertainty, but rather thinking how to deliver all I would like to do on the projects… within the only 3 ½ remaining months!!!

Before I will start to share more specific experiences, I will use this first blog to give an answer to these 3 questions (as of today) i.e. describe my mission in his context.

I will shortly publish a second blog to share my experience during a field trip last week in Nairobi.

A: Where I am

The answer is: I am a member of Health Department, Health in Complex Settings unit, Immunization Workstream team.

Hmm, What does it mean:

[extract from “White Paper” AOF 4 Health and Care (Health in Complex Settings) – July 2017]
“The IFRC works with National Societies to deliver integrated community health and care services and to strengthen national health systems both in developmental and emergency contexts. It supports National Societies in designing, implementing and evaluating the systems that are needed to respond to community health issues, vulnerabilities and risks. These systems are designed to be scalable, sustainable, equitable, adaptable and cost-effective.”
Fragile and complex settings are home to one-sixth of the world’s population and often face the double challenge of fractured health systems and reduced capacity to absorb external funding (due to few partners on the ground with access). Violence, conflict, repeat disasters and disease outbreaks, corruption, exclusion or discrimination of certain groups, and gender inequalities are also common characteristics. Globally, 60% of all preventable maternal deaths and 53% of preventable under-five deaths are concentrated in complex settings. Approximately 60% of the world’s unimmunized children live in these contexts, as do an estimated 60% of people living with untreated HIV and TB.
The evaluation of successes and failures of the Millennium Development Goals (MDG) opened up an intensified focus on reaching the pockets of high morbidity and mortality that remain, largely concentrated in complex settings. There was an explicit recognition that underinvestment in the most difficult circumstances had an adverse impact on putting the last mile first and truly reaching the most vulnerable populations that have limited to no access to formal or informal health care. Achievement of Sustainable Development Goal 3 (SDG3) – Ensure healthy lives and promote well-being for all at all ages, will be impossible without increasing efforts to reach the last mile first, particularly in the most challenging country contexts. 
Where we are strategically
The vision of the Health in Complex Settings (HCS) Team is to support National Society and Movement efforts to ensure access to health and strengthen resilience for the most vulnerable and marginalised populations living in complex settings.
The HCS Team focuses on settings of complex reach (e.g. populations with very high preventable mortality rates living in areas where instability, recurrent crises and weak health infrastructure limit the provision of health services and/or where a significant proportion of the population is beyond the reach of government) and of complex access (e.g. people with specific health needs and risks who are socially distanced and where discrimination and stigma limit access to health services). The overall aim is to proactively and pragmatically cover the last mile first and reach the socially distanced. The Team’s activities relate to AOF4 (health), but also encompass objectives related to AOF6 (social inclusion) and AOF7 (building a culture of non-violence and peace).
The HCS Team has four work streams focused on supporting National Societies and their Ministries of Health to deliver health services in complex settings (see Annex 1). The Team works with and through major global health initiatives, as well as other mechanisms, to support National Societies to reach those most in need. This is done through applying the Red Cross Red Crescent’s Fundamental Principles and humanitarian mandate to alleviate suffering and promote a culture of dignity and peace, as well as through working in partnership with partners in the shared humanitarian space.
Activities under the Active Outreach Work Stream include supporting National Societies and the Global Health Team to work with unreached and untreated groups or communities, including key populations vulnerable to HIV and TB and people who use drugs, to achieve ambitious global goals in HIV and TB and mobile populations.
Under the Reproductive and maternal health (RMH) Work Stream, the IFRC is currently scaling up programming with a focus on emergencies and implementation in fragile states, including strengthening the capacity of National Societies to achieve effective implementation of RMH services on the ground. Evidence-based interventions, guidelines, commodities and supplies within a quality of care improvement framework will contribute to the implementation.
The Immunization Work Stream has two key components: (1) support to National Societies for routine and supplementary immunisation activities and (2) host to the GAVI CSO platform.
The Malaria Work Stream has two key components: (1) technical and financial support to National Societies engaged in malaria activities; and (2) hosting of the global partnership, the Alliance for Malaria Prevention (AMP) providing support to countries for scaling up and sustaining coverage with long lasting insecticide treated nets for malaria prevention, and establishing global guidance on best practices for LLIN delivery and universal coverage.
[end of extract]

In this context, my mission will focus on the project in charge of immunization of children in Central African Republic.

As a secondary activity, I will also work with GAVI CSO team to support them in improving the communication and collaboration between the different international and national organizations involved in the constituency.

A: What are the objectives:

1. Project for Routine Immunization of children in Central African Republic (CAR)

Program Overview


  • Conflict in CAR has devastating repercussions (physical infrastructure and human resources) on the “Program for extended Vaccination” (PEV/EPI),
  • Decrease of routine immunization led to cohort of children un- and under-vaccinated

Target: Reach 80% of vaccination for children <1y and <5y

Proposal: IFRC has been mandated by UNICEF and Global Fund to provide catalytic technical assistance to the government to overcome key data-for-management challenges affecting vaccine management and service delivery.

Project Objectives

IFRC objectives is to provide catalytic technical assistance to the government, by:

  • Improvement of Data Collection (based on mobile phones technology)
  • Improvement of Reporting (e.g. immediate feedback, analysis reports)
  • Training & Support on Service Delivery/Microplanning
  • Technical and Strategic support (data management and coordination)

A: What I can deliver:

Both objectives require the implementation of an Information Management System:

  • As a Data Warehouse for the whole information lifecycle (from collected raw data to final cleaned-up/analysed data)
  • To be Integrated with Data Analysis and Reporting systems (e.g. Strata)
  • Including communication/collaboration features

These are the challenges I will embrace for the remaining days of my mission.

The difficult context, the limited budget and resources constraints make me scared about how much can be delivered by the end of the year. But there is no doubt about the urgent need to change the situation and I know that any stone added to the edifice will help to save children life.