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Securing Health: Lessons from Nation-Building Missions Center for Domestic and International Health Security A RAND HEALTH PROGRAM THE ARTS This PDF document was made available CHILD POLICY from www.rand.org as a public service of CIVIL JUSTICE the RAND Corporation. EDUCATION ENERGY AND ENVIRONMENT Jump down to document6 HEALTH AND HEALTH CARE INTERNATIONAL AFFAIRS The RAND Corporation is a nonprofit NATIONAL SECURITY research organization providing POPULATION AND AGING PUBLIC SAFETY objective analysis and effective SCIENCE AND TECHNOLOGY solutions that address the challenges SUBSTANCE ABUSE facing the public and private sectors TERRORISM AND HOMELAND SECURITY around the world. TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE Support RAND Purchase this document Browse Books & Publications Make a charitable contribution For More Information Visit RAND at www.rand.org Explore RAND Center for Domestic and International Health Security View document details Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non- commercial use only. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents. This product is part of the RAND Corporation monograph series. RAND monographs present major research findings that address the challenges facing the public and private sectors. All RAND mono- graphs undergo rigorous peer review to ensure high standards for research quality and objectivity. Securing Health Lessons from Nation-Building Missions Seth G. Jones • Lee H. Hilborne • C. Ross Anthony Lois M. Davis • Federico Girosi • Cheryl Benard Rachel M. Swanger • Anita Datar Garten • Anga Timilsina The research described in this report was carried out under the auspices of the RAND Center for Domestic and International Health Security, a program within RAND Health. Primary funding for the project was provided by a generous gift from David and Carol Richards. Library of Congress Cataloging-in-Publication Data Securing health : lessons from nation-building missions / Seth G. Jones ... [et al.]. v. ; cm. “MG-321.” Includes bibliographical references. Contents: Germany—Japan—Somalia—Haiti—Kosovo—Afghanistan—Iraq— Evaluating health reconstruction. ISBN 0-8330-3729-3 (pbk. : alk. paper) 1. Medical assistance—Evaluation. 2. Medical assistance, American—Evaluation. 3. Health planning—international cooperation. 4. Public health—International cooperation. 5. Nation-building—Case studies. 6. War—Health aspects. 7. Post-war reconstruction—Health aspects. I. Jones, Seth G., 1972– . II. Rand Corporation [DNLM: 1. Health Planning. 2. Delivery of Health Care—organization & administration. 3. International Cooperation. 4. Public Health. 5. Social Planning. 6. War. WA 540.1 S446 2006]. RA390.A2S43 2006 362.1—dc22 2005032231 Cover photo: AP/Emilio Morenatti Cover design by Eileen Delson La Russo The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R ® is a registered trademark. © Copyright 2006 RAND Corporation All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from RAND. Published 2006 by the RAND Corporation 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 201 North Craig Street, Suite 202, Pittsburgh, PA 15213-1516 RAND URL: http://www.rand.org/ To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] Preface This monograph presents the results of research conducted by the RAND Corporation on the health component of nation-building op- erations. The purpose of the research was to analyze the activities that countries, international institutions, and non-governmental organiza- tions undertake in rebuilding public health and health care delivery systems after major conflict. In addition, this monograph outlines key principles for the success of such reconstruction efforts and identifies lessons for future nation-building operations. The findings are based on an examination of seven nation-building cases: two at the end of World War II (Germany and Japan); three in the 1990s (Somalia, Haiti, and Kosovo); and two after September 2001 (Afghanistan and Iraq). The results of this study should interest policymakers, practitio- ners, and scholars concerned with the successes and shortcomings of past health efforts. Readers’ comments are welcome and should be addressed to lead authors Seth Jones, Lee Hilborne, and Ross An- thony at the RAND Corporation. Primary funding for the project was provided by a generous gift from David and Carol Richards. This study was conducted under the auspices of RAND Health’s Center for Domestic and International Health Security. A profile of the Center, abstracts of its publications, and ordering information can be found at www.rand.org/health/healthsecurity/. iii Contents Preface ...................................................................... iii Figures ...................................................................... ix Tables...................................................................... xiii Summary ...................................................................xv Acknowledgments........................................................ xxxi Acronyms............................................................... xxxiii CHAPTER ONE Introduction.................................................................1 Definitions ...................................................................4 Methodology.................................................................5 Monograph Outline .........................................................6 CHAPTER TWO Germany.....................................................................9 Historical Context ......................................................... 10 Health Challenges.......................................................... 12 Health Approach and Assessment ......................................... 20 Lessons Learned............................................................ 35 CHAPTER THREE Japan....................................................................... 39 Historical Context ......................................................... 40 Health Challenges.......................................................... 44 Health Approach and Assessment ......................................... 49 Lessons Learned............................................................ 78 v vi Securing Health: Lessons from Nation-Building Missions CHAPTER FOUR Somalia .................................................................... 83 Historical Context ......................................................... 85 Health Challenges.......................................................... 90 Health Approach and Assessment ......................................... 97 Lessons Learned........................................................... 114 CHAPTER FIVE Haiti ...................................................................... 117 Historical Context ........................................................ 118 Health Challenges......................................................... 120 Health Approach and Assessment ........................................ 128 Lessons Learned........................................................... 144 CHAPTER SIX Kosovo.................................................................... 149 Historical Context ........................................................ 150 Health Challenges......................................................... 155 Health Approach and Assessment ........................................ 159 Lessons Learned........................................................... 184 CHAPTER SEVEN Afghanistan............................................................... 187 Historical Context ........................................................ 189 Health Challenges......................................................... 193 Health Approach and Assessment ........................................ 196 Lessons Learned........................................................... 216 CHAPTER EIGHT Iraq ....................................................................... 221 Historical Context ........................................................ 222 Health Challenges......................................................... 228 Health Approach and Assessment ........................................ 238 Lessons Learned........................................................... 271 Contents vii CHAPTER NINE Evaluating Health Reconstruction...................................... 275 Comparative Analysis ..................................................... 277 Lessons Learned........................................................... 280 Moving Forward .......................................................... 298 APPENDIXES A. Methodology ........................................................ 303 B. Factor Analysis .....................................................
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