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The health sector gap in the Southern African crisis in 2002/2003

Andre Griekspoor, Paul Spiegel, William Aldis, Paul Harvey

World Health Organization (WHO) / Overseas Development Institute (ODI) / United Nations High Commissioner for Refugees (UNHCR)

SARPN acknowledges Disasters, 2004, 28(4) as the source of this report.
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The humanitarian response in southern Africa during 2002/3 provoked much debate within the humanitarian system about the severity and causes of the situation as well as the appropriateness of the response. This article uses the term southern Africa ‘crisis’ (throughout this article the authors will continue to use the word ‘crisis’ (without the quotations) to describe the situation for consistency) to refer to the six southern African countries that were included in the UN’s consolidated appeal process (CAP); Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe. The authors acknowledge that there is an ongoing debate about the severity of the crisis, and indeed whether it was a crisis at all, and that the choice of the six countries was a construct of the international community (Darcy et al., 2003; Fedida, 2003).

A critical analysis of the health sector response to the situation in southern Africa will be the focus of this article. The relative neglect of health versus other sectors and the factors behind this neglect will be discussed. The authors argue that an over-emphasis on food-security assessments and related analytical frameworks contributed to a narrow priority setting process. While ill-health related to HIV/AIDS was identified as major causal factor of the crisis, there was a limited humanitarian response to address wider health issues. Interventions to prevent disease and access to adequate curative services to reduce illness and malnutrition-related morbidity and mortality are essential humanitarian response priorities besides the supply of food.

and present a model to aid in its conceptualisation. They then analyse the factors behind this gap in terms of the way the crisis was conceptualised and assessed, the divisions between humanitarian and development assistance and the role of HIV/AIDS. It argues that the health sector gap in the southern Africa response occurred because health was seen as a long-term developmental issue that could not be easily addressed by short-term humanitarian action. However, in much of southern Africa, development actors have failed in their efforts to help the governments to provide acceptable levels of basic health services. Furthermore, access to health services has been declining over a number of years. Questions of and some solutions for the responsibility of humanitarian actors in situations where morbidity and mortality levels do not necessarily reach crisis levels and where access to health is already below minimum standards are proposed.

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