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Understanding Health and Fragility from a Systems Perspective

Fragile, conflict affected situations or ‘fragile settings’ have among the weakest health systems and worst health indicators in the world. Despite this recognition, however, notable gaps in research and tools linking health and fragility remain. For actors working to improve health conditions in fragile settings, the absence of an appropriate conceptualization of fragility cast through a health lens has the potential to significantly hinder an understanding of the environment in which they operate, with implications for the health programs they design and implement.

Recognizing the challenges presented by the absence of a health-sensitive understanding of fragility, Momentum Integrated Health Resilience (MIHR) commissioned IRMA consultants to develop a fragility conceptual model and typology to better understand the fragile settings in which MIHR work is implemented and, in turn, strengthen health programming. The conceptual model developed by IRMA draws on an expansive literature review and a range of fragility and risk measurement frameworks and presents a systems-oriented approach to understanding and assessing fragility and the relationship between key indicators of fragility and health.

MIHR further commissioned IRMA to apply the conceptual model in a comparative analysis of fragility, conflict sensitivity and complexity in MIHR operating countries and the implications for health programming.

IRMA’s team for this assignment was Hannah Vaughan-Lee and Lezlie Morinière.


Photo credit: Mother and child visit a clinic in central Somalia run by soldiers of the African Union Mission in Somalia, courtesy of Abdi Dakan (AU/UN IST PHOTO).

M&E for Protection Prevention in AELA

Photo credit : NRC

The measurement and evaluation of prevention of violence in Protection Programmes is challenging for many reasons. A relationship of trust is needed for communities to be willing to share information about issues affecting their safety, and even when trust exists, establishing a causal relationship between interventions and a reduction in violence requires considering perceptions, lived experiences and considerable contextual knowledge.

Seeking to advance Protection Prevention M&E practices, IRMA is supporting the Norwegian Refugee Council’s (NRC) Asia, Europe, and Latin America (AELA) region to develop a Protection Prevention M&E framework for its Protection of Civilians programmes. The team will assist NRC to develop a suite of tools and methods for country offices and field teams that are adaptive to fluctuating contexts while ensuring evidence is reliable and multi-faceted.

Evaluating the impact of DRR Interventions after disasters

The Oxfam Global Humanitarian Team (GHT) has a Performance and Innovation Team that sets the standards and gathers evidence to document learning in the different thematic areas of Oxfam work, including Disaster Risk Reduction (DRR).

Oxfam’s GHT sought IRMA’s support to develop a methodology to evaluate the impact of its DRR work in communities that are subsequently affected by a disaster. Oxfam wanted to know how it could assess the extent to which investments in DRR had helped beneficiaries to withstand the effects of a hazard event, and whether they were less affected than others who had not participated in a DRR project. In addition, because it would be used in a post-disaster context, Oxfam wanted the methodology to avoid creating a burden for teams on the ground engaged in response work.

IRMA developed an innovative methodology – a Rapid Impact Assessment – for this purpose and supported its successful pilot application in India. Learning from the pilot was incorporated, and in Spring 2022 IRMA will deliver training on Rapid Impact Assessment to Oxfam’s M&E and DRR teams to support a global roll-out.

Evaluation of World Vision’s Disaster READY Program in the Pacific and Timor Leste

The Disaster READY program is aimed at building local humanitarian capacity and preparedness in the Pacific and Timor-Leste, to enable communities and governments to better respond and recover from rapid-and slow-onset disasters. The program is a result of a partnership between the Australian Government (DFAT) and six Australian NGOs, including World Vision Australia. World Vision partners involved in this program are The Australian Bureau of Meteorology (BoM), Christian Blind Mission International (CBM) Australia, Habitat for Humanity Australia (HfHA), and Field Ready.  The program activities and actions within first phase of the Disaster READY program, implemented from 2017 to 2022 in five Pacific Island countries- Solomon Islands, Vanuatu, Papua New Guinea, Fiji, and Timor-Leste will be assessed.

IRMA’s role in this evaluation is to assess the program’s impact, effectiveness, sustainability, and relevance through qualitative data collection methods, secondary data review, and triangulation. The conclusions and recommendations generated by the evaluation will be used to inform the design of the second phase of Disaster READY (starting in July of 2022) as well as inform World Vision Australia’s broader work on disaster risk reduction (DRR), climate change adaptation (CCA), and resilience-building in the Pacific.

Assessment of the effectiveness and quality of BRC’s COVID-19 global response (Year 1)

Globally, as of March 2021, the COVID-19 pandemic has directly claimed nearly three million lives and continues to put lives, health, education, livelihoods, peace and almost every aspect of the society at risk.

Over 14 months since the pandemic was declared, governments, health systems, humanitarian organizations and communities are still struggling to save lives and mitigate the socio-economic consequences.

The British Red Cross (BRC) has been responding to the COVID-19 crisis in a variety of ways, with an overarching principle of contributing to a well-coordinated Movement effort, led at country level by National Societies. By the end of the first year of its response, BRC had provided bilateral support to 36 National Societies in its priority regions, branches in the British Overseas Territories, and through its domestic programme in the UK.

IRMA was commissioned by BRC to conduct a review to provide a succinct assessment of the effectiveness and quality of BRC’s actions, and to share practical ways to improve response design and management for Year 2 of the response and major/global crises in the future.

IRMA’s co-founder, Marilise Turnbull, conducted this review with support from Coverdell Fellow, Anjelica Montano.

Redesign of one of NORCAP’s flagship programs : CashCap

NORCAP is the Norwegian Refugee Council’s global provider of expertise to the humanitarian, development and peace-building sectors. One of NORCAP’s flagship programs is CashCap. Established in 2015/2016, CashCap aims to support humanitarian and development actors in achieving Grand Bargain commitments to radically increase the scale and quality of cash and voucher assistance (CVA) as a modality.

How does this program work in practice? CashCap experts (or “CashCappers”) are deployed to provide inter-agency support at all levels and in all stages of a crisis response. The experts facilitate planning, coordination and implementation of cash programming across the sectors, without an agency-specific agenda. Every mission includes an element of knowledge exchange and learning within and for agencies involved in cash coordination, including CashCap host agencies, national and local stakeholders. Since its establishment, CashCap has deployed senior experts to 38 different countries across 6 regions. Their impartiality, technical know-how and their operational experience mark the CashCap quality brand.

Last year, NORCAP commissioned IRMA to support the redesign of CashCap, leading to the development of NORCAP’s new Cash and Markets strategic plan for the next 3 years (2022-2025). IRMA carried out this assignment in a highly participatory manner, engaging a wide range of stakeholders that operate within CashCap’s and NORCAP’s spheres of action.

The first stage in this process was landscape analysis, comprised of a Systematic Literature Review and consultations with 32 people from 20 entities.  The landscape analysis enabled CashCap/NORCAP to consider various options for the future direction of its Cash and Markets portfolio, opting for a focus on strengthening national and local leadership of CVA, supporting innovation and integration, and strategically deploying experts to facilitate coordination in major and complex crises.

The implications of this focus were discussed in workshops with stakeholders in three different crisis contexts: Venezuela, Somalia and Whole of Syria. The purpose of this step was to ensure that local and national organisations had a say in CashCap’s planning and to provide key contextual inputs. Informed by these consultations, IRMA conducted a survey on ‘the future direction of CashCap’, targeted at CashCap experts, host agencies, humanitarian leaders, donors, national NGOs, national governments, and other stakeholders who have interacted with CashCap.

Based on all the above-mentioned inputs, a theory of change was developed in workshops with regional experts, NORCAP representatives and external stakeholders, leading to the development of CashCap’s 2022-2025 strategic plan.

IRMA offers sincere thanks to the CashCap team, particularly to Jimena Perroni, Fe Kagahastian and Noanne Laida who were instrumental in creating a space for local actors in their areas to participate in the strategic development, and Anna Kondakhchyan and Roya Murphy for being open to a very participatory process. IRMA is grateful to all those who joined in virtual discussions, particularly CashCap’s local and national partners for the Syrian, Venezuelan and Somalia crises.

IRMA’s team for this assignment was Marilise Turnbull, Lezlie Moriniere, Floor Grootenhuis and Charlotte Gendre.

Technical assistance to address environmentally induced displacement in EC external cooperation

Climate change has become an increasingly important driver of human mobility. Those displaced due to environmental, or climate factors are not legally represented in the Refugee Convention and no internationally agreed terminology captures their status.

This project will map how the European Union and partners address environment-displacement linkages to establish a more insightful organizational position as EU moves to chair the Platform for Disaster and Displacement (PDD).

IRMA will technically assist to map global actions and policies, to advise EU on specific related technical requests and to develop/deliver online training and briefing materials for the INTPA Academy.

The Contracting Authority is the European Union (EU), represented by the European Commission (EC). The stakeholders involved in this contract include Internal Displacement Monitoring Centre (IDMC), International Organization for Migration (IOM), and Platform for Disaster and Displacement (PDD).

IRMA conducts “Environmental Considerations in Humanitarian Response” Training of Trainers for International Organization for Migration (IOM)

As part of our ongoing technical support to International Organization for Migration (IOM) in Guatemala, IRMA designed and conducted the first round of a “Training of Trainers” on the incorporation of environmental considerations in humanitarian response to population displacement in Guatemala. Following a positive evaluation of the first round, IRMA will conduct a second round of the training in November 2021.

The training, which is provided in Spanish, aims to:

1) Strengthen participants’ knowledge about environmental impacts that result from humanitarian response to migration,

2) Develop participants’ capacities to identify ways to prevent and mitigate such impacts,

3) Equip participants with resources and techniques to replicate the trainings within their respective institutions.

Each session applies an environmental lens to assess unintended negative impacts that result from humanitarian responses in shelter, WASH, health and wellbeing, food, livelihoods, gender, and protection programming. Critical thinking exercises, use of visual and game-like applications (Miro, Kahoot) and a peer-to-peer learning approach encourage and sustain participant engagement and interest.

The course culminates in a virtual simulation of a humanitarian response to a sudden, massive migration flow. Participants test their newly acquired knowledge and skills to design and deliver an environmentally-responsible response.

The training is led by IRMA partner Marilise Turnbull, with research and technical support from Chandler Smith.