Coordination of health-service provision in humanitarian crises: a systematic review of suggested models

Abstract Background National and international humanitarian relief organizsations play an important part in humanitarian crises. There is evidence of lack of coordination between organisations providing health services in public health emergencies. Our objective was to identify published models of coordination between organisations funding or delivering health services in situations of humanitarian crisis worldwide. Methods We followed standard systematic review methodology. We searched Medline (1946 to week 1 of March, 2014), PubMed, EMBASE (1980 to week 10 of 2014), the Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library. We only included papers published in English. We used search terms such as "refugee", "disaster", "conflict", "coordination", "cooperation", "international organization" and "non profit organization". Two teams of two reviewers screened titles and abstracts in duplicate and independently for potential eligibility, retrieved full texts of citations judged as potentially eligible by at least one reviewer, screened full texts in duplicate and independently for eligibility, and resolved disagreement by discussion. When disagreement was not resolved, a third reviewer made the final decision. We also searched websites of relevant organisations. One reviewer reviewed titles of search hits. We then obtained full texts of articles identified as potentially eligible, and two reviewers screened them in duplicate and independently, compared their results, and resolved any disagreement by discussion. We included reports describing models of coordination in sufficient detail to allow reproducibility. We also included reports describing implementation of identified models as case studies. Findings Our search captured 14 309 citations. The screening process identified five models of coordination of delivering health services: the health cluster approach (with 15 case studies), the "who is where, when, doing what" mapping tool (4Ws; four case studies), the sphere project model (two case studies), the 5×5 model (one case study), and the model of information coordination (one case study). The 4Ws and 5x5 models focused on coordination of services for mental health, while the remaining models did not focus on a specific health topic. The health cluster approach appeared to be the most widely used. One case study used a mixed implementation of the health cluster approach and the sphere model. We did not identify any model of coordination related to funding of health services. Interpretation This systematic review identified three proposed coordination models that have been implemented by organisations funding or delivering health services in situations of humanitarian crisis. There is a need to compare the effectiveness and efficiency of these different models. Funding Alliance for Health Policy and Systems Research, National Council for Scientific Research.