Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review.

BACKGROUND: Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. METHODS: We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. RESULTS: Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. CONCLUSION: This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field

Assessing storm surge risk under future sea-level rise scenarios: a case study in the North Adriatic coast

Low-lying coastal areas are often prone to storm surge flooding that can render severe damages to properties, destruction of habitats, threat to human safety and the environment. The impacts of coastal flooding are also expected to increase in the future as a consequence of global climate change and sea-level rise. This paper presents a comprehensive assessment of the potential risks raised by storm surge and sea-level rise on multiple coastal targets (i.e., population, buildings, infrastructures, agriculture, natural and semi-natural environments and cultural heritage) in the Northern Adriatic coast in Italy. Through the assessment of hazard, exposure, vulnerability and risk, a Regional Risk Assessment (RRA) methodology allowed identifying and prioritizing hot-spot risk areas and targets requiring particular attention for the definition of adaptation strategies. Hazard scenarios were based on the analysis of tide gauge data (elaborated with the Joint Probability Method) and of different sea-level rise projections for the year 2100. Geographical-information analysis was then used to characterize vulnerability patterns of exposed natural and human systems and to make a spatial ranking of risks. Maps produced for the worst scenario showed that beaches are the target at higher risk (with more than 90% of the surface in the higher relative risk class) due to the low elevation and high proximity to the coastline. Also cultural heritage (i.e., villas, historical buildings and roads) and wetlands are highly threatened by storm surge flooding. The relative risks will be lower (i.e., between 25% and 40% of their surface/length in the higher relative risk class) for most of the other receptors (i.e., local roads, railways, natural and semi-natural environments and agricultural areas), including population and buildings that are mostly classified in lower risk classes. The overall results of the assessment, including maps and risk metrics, can be useful to rise the attention of coastal managers about the need to adapt to climate change, developing climate-proof policies and programs for the sustainable management of coastal zones