Supporting Healthier and More Accountable Aid Design and Delivery (CBR project)

Overview

Background

The aim of the project was to diffuse the work of the R4HC research project to policy makers in the UK government (FCDO), UN agencies (World Bank, IMF, WHO), and NGOs with an interest in the delivery of more effective health outcomes in the Middle East. Funding provided for two workshops and related activities including a documentary film and planning for an edited book. Our earlier GCRF-funded research, conducted under the auspices of the R4HC project, had looked at the impact of continuing conflict and unstable forms of governance on the delivery of public health systems in the Middle East and North Africa (MENA) region. One of the findings from this earlier research had been to flag up ways in which decision makers could find entry points in the policy process in Lebanon, Jordan and Gaza, with a view to ensuring that donor aid money was spent in such a way as generate health impacts on the ground. Previously there was little donor understanding in these countries of how internal policy processes and decisions are made. Follow on funding from the GCRF programme for the present project gave us the opportunity to disseminate our research outcomes to critical decision makers in the MENA region. It also provided us with the means to reach out to policy makers concerned with understanding the factors affecting the mental health pressures on refugees from the Middle East to the UK, and on host populations in communities receiving refugees. The key audiences here included decision makers in UK central and local government, the NHS, and UK-based NGOs.

Aims and objectives

Funding provided for 2 workshops and a range of dissemination activities including the production of short documentary films and the planning of an edited book. The project aimed to address the following questions:

• How can humanitarian policy could better understand and integrate a more systematic political economy approach to policy design, delivery and implementation in Syria, including with reference to the health impacts of the recent earthquake?
• How can asylum, refugee, health, development and humanitarian policy be brought together in order to provide a more holistic, equitable, cost effective and humane approach to stabilising people’s lives?
• Are there commonalities and shared lessons of what works and what does not work from the spectrum of contexts in which refugees, asylum seekers and vulnerable host communities access mental health services?

Progress

First Workshop: Political Economy of Health Analysis – Northern Syria

The first workshop was held online on 23 February 2023 at 12:00 noon UK time, 14:00 Beirut time. This was a closed event to which we invited a small group of donors, researchers and frontline workers from Northern Syria. Those participating included officials from the Foreign, Commonwealth and Development Office (FCDO), the EU’s Syria programme (EU Syria), USAID, the German Development Agency (GIZ), and the World Bank (Human Development Team for Middle East and North Africa).

The work of the R4HC project was presented and its significance noted for post-earthquake situation. It was already clear that politics and systems of governance in the health systems were playing a role in shaping responses in each country. There was a discussion of how the PEOH (political economy of health) approach was important for Syria in highlighting the barriers and opportunities to make changes to health policy.

The main outcome of the workshop was a set of recommendations for future research on targeted health investments and policy development, to guide policy and decision-makers working on Syria.

The content of the discussion and recommendations helped in the drafting of a proposal for future funding, and provided content for the Syria chapter of the R4HC book.

Second Workshop: Improving the Design and Delivery of Mental Health Services for Vulnerable Groups in the United Kingdom – The Experiences of Refugees, Asylum Seekers and Local Populations at Risk: An Academic-Policy Knowledge Exchange Workshop

The second workshop was held on Tuesday 21 March 2023 at the Royal Society of Medicine, London. It brought together community of practice stakeholders (academics, frontline workers and policy decision makers) to examine the challenges of designing mental health services for vulnerable groups in the United Kingdom, including local domestic at-risk populations, refugees and asylum seekers coming from the Middle East and North Africa (MENA) region. Those participating included: representatives of frontline public services and civil society in the UK (NHS, Doctors of the World UK, Médecins sans Frontières UK, Helen Bamber Foundation, Solace, UCLH Respond, Freedom from Torture, Action West London, British Medical Association); civil society and humanitarian agencies from the Middle East and North Africa region (UNHCR, Medair, Doctors of the World, International Medical Corps); and refugees and asylum seekers from Syria.

The workshop began with an overview of key findings from the R4HC project. Speakers provided an overview of the situation of migrants in the UK and how current government policy is treating people escaping from persecution and illness. The presentations stressed the importance of raising awareness for reducing mental health-related stigma, breaking down the barriers to mental health care and empowering, dignifying and humanising people living with mental health conditions. The workshop then heard of the experiences of frontline workers from Syria and Lebanon and frontline workers in the United Kingdom. It finally heard from two refugees who had travelled to the UK from Syria, via Lebanon, seeking asylum. They described the difficulties they had faced and how it had affected their mental health, but also their resilience to overcome these challenges and start a new life. Participants generally reflected on the overlapping trauma that migrants forced to flee suffer from: the trauma of living in a war zone, fleeing their country, being exposed to discrimination, and struggling to have a right to live and work with dignity.

Films

The films supported by the grant will be in the form of 3 short documentaries (3 mins each) covering the issues below. These are due to be completed by the end of summer 2023.

• Two films on the experiences of frontline workers in providing mental health support to refugees
  These films relate the experiences of health advisers and former refugees and asylum seekers in the UK. We have reached out to a number of organisations who will take part in the making of the film.
• One film on the policy response
  This film features interviews with the chief scientist of the Home Office, the head of mental health for the Department of Health and Social Care, and a representative from NIHR East of England. It provides insights into current government approaches to refugee and AS policies at the national and local levels.