REfugees in Africa ClusTer (REACT): humanitarian health policy, gender and health economics

全球有超过2500万难民，这是自第二次世界大战结束以来的最高数字。符合官方发展援助资格的国家，许多在非洲，收容了大多数难民人口；仅乌干达就收容了136万难民，是世界上第三大难民收容国。绝大多数难民处于长期、长期的流离失所状态。在人口层面上，收容人口与难民人口之间以及难民社区内部往往存在明显的社会和健康不平等。例如，与男子和男孩相比，难民（和国内流离失所者）妇女和女孩更不可能安全地获得食物、保健、住所、国籍和证件，而且更容易受到性暴力和性剥削。对长期流离失所环境的应对措施通常是制定单独的平行卫生应对措施，其中国际捐助者的资金主要用于国际非政府组织，而较少用于东道国政府；即使在努力使难民人口融入收容社区的地方。虽然有助于解决短期需求，但从长期来看，这种做法有可能削弱公共卫生系统的应对能力和社区凝聚力。例如，它可能导致政府和非政府组织的反应缺乏协调和效率低下，使国家治理机制支离破碎，转移政府的资金和专门知识，并破坏国家战略计划。平行做法还意味着，由于孤立地应用众多宣传和发展方案，解决社会和保健不平等问题的机会有限。总的来说，目前人道主义反应的性质是不可持续的，因为它未能建立长期的国家能力，以便在需要出现时有效和公平地作出反应。非洲难民小组（REACT）旨在通过与来自东部、中部和南部非洲区域（包括斯威士兰、肯尼亚、莱索托、马拉维、毛里求斯、坦桑尼亚、乌干达、赞比亚和津巴布韦）的决策者合作，在卫生治理、政治经济学、难民卫生需求、卫生经济学和性别分析等领域的专家研究人员，对这种情况作出反应；由欧洲经委会卫生界共同代表。REACT将集中两个现有的大型全球卫生应急基金规划：由约克大学领导的Thanzi la Onse（全民健康），侧重于卫生经济学和相关研究，为欧洲经委会区域的资源分配提供信息；由伦敦卫生和热带医学学院（LHSTM）领导的RECAP侧重于人道主义危机中的卫生问题。它将包括欧洲经委会区域两个主要研究机构的伙伴关系，它们设在全球难民人口最多的国家之一：乌干达的马凯雷雷大学公共卫生学院；以及肯尼亚的KEMRI-Wellcome Trust。这一伙伴关系还将受益于其他研究小组的参与，这些研究小组有很大潜力产生知识，有助于设计适合难民保健需求的对策——埃塞俄比亚亚的斯亚贝巴大学；挪威卑尔根大学；以及英国的海外发展研究所。在初步绘制利益相关方地图后，REACT集群团队将支持ECSA-HC召开由该地区主要专家和利益相关方组成的研讨会；代表受影响人群；学术界和政策制定者。将在REACT联合调查员领导的工作包中调查4个不同的研究主题；共同促成工作组的报告。工作组的报告将向GCFR集群第2阶段呼吁（强调研究领域、加强能力的途径和从研究到政策的伙伴关系）提交一份完整的报告。

There are over 25 million refugees globally, the highest number since the end of the Second World War. ODA-eligible countries, many in Africa, host the majority of the refugee population; Uganda alone hosts 1.36 million refugees and is the third largest refugee-hosting country in the world. The vast majority of refugees are in long-term, protracted displacement situations. At a population level, there can often be stark social and health inequities between host and refugee populations, as well as within the refugee community itself. For example, refugee (and internally displaced) women and girls are less likely than men and boys to have secure access to food, health care, shelter, nationality and documentation, and are more vulnerable to sexual violence and exploitation.The response to protracted displacement settings has commonly been the development of separate parallel health responses in which international donor funding is directed largely towards international NGOs, and less so towards host governments; even where there are efforts to integrate refugee populations within host communities. While helping to address needs in the short-term, this approach risks weakening the public health system response and community cohesion over the longer term. For example, it can cause poorly coordinated and inefficient responses by government and NGOs, fragment national governance mechanisms, divert financing and expertise away from government, and undermine national strategic plans. Parallel approaches also mean that the opportunity to address issues of social and health inequity are limited, through the siloed application of numerous advocacy and development programmes. Overall, the current nature of humanitarian response is unsustainable as it fails to build long term national capacity to respond effectively and equitably as needs arise. The REfugees in Africa ClusTer (REACT) aims to respond to this situation by partnering specialist researchers - in the areas of health governance, political economy, refugee health needs, health economics and gender analysis - with policymakers from the east, central and southern Africa region - comprising Eswatini, Kenya, Lesotho, Malawi, Mauritius, Tanzania, Uganda, Zambia and Zimbabwe; represented collectively by the ECSA Health Community. REACT will cluster two existing large GCRF programmes - Thanzi la Onse (Health of All), led by the University of York, focused on health economics and related research to inform resource allocation in the ECSA region; and RECAP, led by the London School of Hygiene and Tropical Medicine (LHSTM), focused on health in humanitarian crises. It will include partnership of two major research institutes in the ECSA region, based in countries with amongst the largest refugee populations globally - Makerere University, School of Public Health, in Uganda; and KEMRI-Wellcome Trust, in Kenya. The partnership will also benefit from participation of other research groups with major potential to generate knowledge to contribute to designing suitable responses to refugee health needs - the University of Addis Ababa, Ethopia; University of Bergen, Norway; and the Overseas Development Institute in the UK.Following an initial stakeholder mapping, the REACT Cluster team will support the convening of a workshop by the ECSA-HC comprising key specialists and stakeholders from the region; representing affected populations; academia and policy-makers. 4 distinct research themes will be investigated, in work packages led by REACT Co-Investigators; collectively leading to a Working Group report. A full submission to the GCFR Clusters Phase 2 call - highlighting areas for research, ways to strengthen capacity and research-to-policy partnerships - will be developed out of the Working Group report.