The emergency-to-development continuum: left to right, or right to left?

As global health and international development professionals, our assumption is often that the continuum between emergency and development goes:

Emergency –> to –> Development,

left-to-right.

As global health and community health professionals, we have to or we tend to look at the situation as technicians, clinical technicians, social and behavior change technicians, health systems governance, and management technicians, leaving the questions of why fragility occurs to social change activists and advocates. We are now more often paying attention to public and private sector accountability to citizens, through the lens of the necessary governance and leadership of health systems, clearly delineated in a 'building block'. And we focus this attention on the need to ensure quality of services, the requirement that health systems be responsive to clients, so that utilization increases and our interventions reach scale. We trade very cautiously on these democracy and governance issues – actually, we generally like to focus on governance and say little about democracy. Our individual beliefs, motivations, and passions are still heavily humanitarian, socially-oriented, and democratic. But during office hours, we couch them in skilled technical language. After all, in terms of improving health outcomes, the best performing countries are not necessarily the most democratic ones.

Some of us at least, and certainly in polite company, enter the world as neutral technicians, even if we are passionate about democracy and global justice. And there’s a reason for it: our legitimacy and credibility stems from this neutral technicity; it allows us to come in, respond to human suffering, and act on the levers of health systems behaviors – including at community level – to redress the performance of health systems. We inherit a world full of emergencies, and now we are questioning how we can get better at moving along the continuum from left to right: Emergency – to – Development. That’s our job; that’s where we make a difference; and our activist, rambunctious, political self does well to leave the stage to the community health or health system professional that we are.

But what if the world was not going left to right, but more and more, in so many places, right to left:  development-back to-emergency, via a path of chaos?

Let’s consider examples related to both internal and external influences:

•        A country successfully moving on MDG and now SDG indicators, but creating substantial anti-democratic spaces: regional imbalance, presidency-for-life, ethnic blind spots if not repression, leading to an undercurrent of popular discontentment, one day resistance, uprising, violence, implosion of the national model…    
•       A relatively stable country with a functioning health system becomes a pile of rubble, sent back generations in its development due in large parts to foreign interventions and acts of wars, including by industrialized nations, who happen to also be well-meaning donors…
•       Global economic models come to prominence, with long ramifications and ripples in terms of the economic choices of nations, the potential corrupting factor of massive amounts of funds, displacement of social investments away from the poor, and increased national blind spots about the needs of the poor and vulnerable.
•       Unmitigated environmental destruction and global climate change hit large regions severely, leading to increased humanitarian crises, aggravated social, economic, and ethnic upheaval, increased numbers of refugees, and corollary decreased ODA funds for development.

If these are rare and unfortunate occurrences, then we are better off to leave this to the activists, peacemakers, and social justice advocates of the world. The world is still going left-to-right; our entry point into technical issues will allow us to play our role for progress, while ‘staying in our lane’.

But if these are trends and not exceptions, if more often than not such factors lead the world to go:

Emergency <– to <– Development,

right to left,...

...then our cautious neutrality may lead us to see a lot of our work undermined or even wrecked to ruins tomorrow. We will face constant degradation on a large scale, persistent and intractable emergencies, our left to right emergency-to-development continuum will revert to theory, overtaken by downward spirals and de-development. If this is the case, then our neutrality does not facilitate our work, but rather undermines the sustainability of any progress we achieve.

So, which is it? Left to right? Or right to left? And what does it mean for us?