Credit: ADB/Nepal
A family beside a damaged house near Naglebhare, Nepal

Emergencies and fragile states

When resource-poor countries are struck by natural disasters or conflicts, restoring health services is a life-saving priority. Supporting coordination and planning with international and national partners can be key to an effective – and timely – response. In fragile states, where the government cannot or will not deliver core functions for the majority of its people, communities have few resources to cope with unexpected events or pay for access to essential services such as health care. In these situations, it is often women’s and children’s health and lives that are most at risk – resulting in high maternal and child mortality.

We work in these often challenging and difficult situations by:

  • Building capable communities and systems in both primary and other health services; we call this  ‘Build Back Better’
  • Reaching ‘hard-to-reach’ populations in remote areas, particularly women and children who are often most affected by poverty, conflict and lack of access to services
  • Developing health-financing solutions that improve the flow of money into the health systems so that it can reach frontline services
  • Supporting planning from central to facility levels, to ensure that partners work in synergy and make the best use of available resources
  • Strengthening engagement and accountability systems so that people and communities build trust in their health services (and in turn, their governments).

In Yemen, our voucher specialists work with our Yemeni NGO counterparts Yamaan to deliver life-saving primary and emergency care for women. Safe Motherhood and Family Planning vouchers are distributed to pregnant or married women in need of services. These are then redeemed nearby in safe, reliable health facilities.

In Nepal, we have been working with the Ministry of Health and Population (MoHP) to support their post-recovery and transition programme since the earthquakes in April/May 2015. This includes supporting assessment of buildings, conducting repairs and maintenance, helping restore the functionality of essential health care services, and providing psychosocial and rehabilitation support to people most affected by the trauma of the earthquakes and significant aftershocks.

In Sierra Leone, we used our understanding of the health system to provide rapid, effective support to the national response to the Ebola outbreak. We adapted the Quality of Institutional Care (QuIC)/Facility Improvement Team (FIT) tool to perform swift assessments of whether facilities were ready to deal with Ebola cases, conducted rapid research on the impact of Ebola on reproductive health services, and worked with the national Laboratory Technical Working Group (LTWG) to strengthen laboratory testing and diagnosis of Ebola cases.


120,000 vouchers have been distributed by the Yemen voucher programme since 2013

Turnaround time for Ebola testing has reduced to below 12 hours in Western Area in Sierra Leone

Our experts

  • Sara Nam, PhD
    Sara Nam is a public health professional with close to 20 years’ experience providing technical assistance to and implementing health programmes and conducting research and programme evaluations. Sara is a qualified midwife, bringing technical expertise in the design and delivery of maternal and newborn health services, health planning and management, strengthening human resources and improving quality of care. Sara has supported health programmes in a variety of development and emergency situations and fragile states, most recently in Sierra Leone during the Ebola outbreak.

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More about Options
Established in 1992, Options has worked in over 50 countries. We lead and manage health sector programmes on behalf of international donors and national governments.
Established in 1992, Options has worked in over 50 countries. We lead and manage health sector programmes on behalf of international donors and national governments.

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