Actions taken:
Pledge objective 1: To establish a multi-year, renewable, collaboration which is globally applicable and based on co-creation, adaptation or adoption of technical standards in RMNCAH.
ICRC and CRC’s shared commitment to the provision of high-quality healthcare during conflict, led to the Advanced Partnership in Health (APiH) agreement, focusing on delivery of community based RMNCAH services. The APiH framework was developed, and two pilot projects were implemented in South Sudan and Central African Republic (CAR) between 2019 and 2023.
In addition to program implementation and evaluation, a proof-of-concept study was also designed and conducted during the implementation phase. The study was completed in 2021 and highlighted the critical need for accessible RMNCAH interventions in conflict-affected areas, where maternal and child mortality rates were high. It demonstrated the feasibility and necessity of delivering community-based health services in conflict zones. The successful implementation of community based RMNCAH interventions in acute conflict settings was evidenced by two pilot projects’ baseline assessments.
Despite various barriers, including security concerns and resource mobilization, substantial progress was made. The findings from the project revealed that community-based support was essential during times when accessing health facilities is challenging, including during armed conflicts. Community approval and collaboration were crucial for scaling up APiH interventions, emphasizing early prevention and detection of RMNCAH-related issues.
Engaging diverse community groups, especially women and adolescents, was vital beyond traditional community leaders. A peer-reviewed manuscript was jointly published by CRC and ICRC in BMC Health Services Research, titled Implementing community-based health program in conflict settings: documenting experiences from the Central African Republic and South Sudan.
Several challenges were encountered during this period that offered an excellent learning opportunity for scaling up. Resource mobilization for this project became an issue during the pandemic. Additionally, researchers could not travel to the project sites to collect data for proof-of-concept study due to the pandemic. Data collection was improvised through remote support for the proof of concept, however, the delays in program implementation resulted in limited data for the study. Security was another challenge—although designed to be delivered in conflict settings, there were areas in CAR, where the activities could not begin because of extremely heightened security related issues and travel restrictions.
Pledge objective 2: To impact effectively and positively, with a public health approach, on the continuum of care for women and children from household and community level with a focus primary and secondary level health care through joint service-delivery where and when possible.
Based on community leader consultation in South Sudan and community consultations at village level in CAR, the programs within the APiH framework were delivered based on the needs identified by the community.
Joint RMNCAH activities, including primary level care and referrals, were completed in two countries: CAR and South Sudan.
National societies in South Sudan and CAR were engaged in planning and implementation. In order to sustain the outcome of the pilot project, CRC extended one year of bilateral programming support to South Sudan Red Cross and is exploring similar support in CAR with a long-term view.
The APiH framework co-created by ICRC and CRC provided the evidence-based framework to guide the standardization and implementation of quality community-based health programming.
The pilots were monitored and evaluated for key indicators, baseline and endline evaluations were completed for both projects. Additionally, CRC analysed the data to explore the impact of the program implementation. External evaluation of the partnership provided important insights for future programming. The proof-of-concept study was shared with ICRC, South Sudan Red Cross and Central African Red Cross and their feedback was incorporated. The lessons were also widely disseminated through a peer reviewed publication.
The APiH framework was tested in a Proof-of-concept study in the pilot project countries and areas. The evidence from the study showed that implementing an integrative community-based approach to health service delivery in CAR and South Sudan is viable for humanitarian organizations operating in conflict zones. To ensure swift and responsive implementation of health services in such challenging environments, decision-makers should prioritize engaging communities effectively, addressing inequities by involving vulnerable groups, negotiating for safe passage to deliver services, considering logistical and resource limitations, and tailoring service delivery with the assistance of local actors.
Due to the unavailability of financial resources and changing priorities, the program could not be scaled up. However, both CRC and ICRC remain committed to scale it up if resources are available in the future.
