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Exploration on health and peace programming – Libya

Interpeace is an international organization for peacebuilding. With over 25 years of experience, it has implemented a broad range of peacebuilding programmes in Africa, the Middle East, Asia, Europe, and Latin America. Interpeace was officially recognized as an international entity by the Swiss Federal Council in 2018.

Interpeace tailors its approach to each society and ensures that its work is locally designed and driven. Through local partners and its own local teams, it jointly develops peacebuilding programmes based on extensive consultation and research. Interpeace helps establish processes of change that promote sustainable peace, social cohesion, and resilience. The organization’s work is designed to connect and promote understanding between local communities, civil society, governments, and the international community. Interpeace also assists the international community – especially the United Nations – to play a more effective role in peacebuilding, based on Interpeace’s expertise in field-based work at grassroots level. Interpeace achieves this primarily by contributing innovative thought leadership and fresh insights to contemporary peacebuilding policy. It also assists the international community through ‘peace responsiveness’ work, in which Interpeace provides advice and practical support to other international organizations (especially those in the security, development, and humanitarian aid sectors), enabling them to adapt their work systemically to simultaneously address conflict dynamics and strengthen peace dynamics. Interpeace is headquartered in Geneva, Switzerland, and has offices around the world.

General context

Libya has yet to find a suitable formula that could lead to legitimate, inclusive, and effective state institutions. The country’s transition has been dogged by insecurity and instability, and the capricious disposition of militias towards anarchy. Libya has witnessed some very promising political developments during 2021. This political momentum was encouraged by the international community with many countries insisting on the importance of putting an end to the conflict by starting an inclusive political process. However, this is not without its challenges: both at the central and local levels.

The timeframe to hold elections at the end of the year (24 December 2021) is extremely ambitious. Moreover, trust in electoral process, and indeed in state institutions writ-large, is extremely low.

One of the worst-hit sectors is healthcare, which has been battered by conflict. Many medical facilities have been damaged in the fighting, some were forced to shut down because they were close to the frontlines, and others are decaying from underinvestment. Thus, health services are becoming progressively unavailable. Half of the health facilities that were operational in 2019 are no longer functioning due to the security situation. While hospitals are supposed to be serve as safe havens, in much of Libya, they are another casualty of an increasingly damaging conflict. A decade of conflict left Libya’s health system on the verge of collapse. The onset of the pandemic posed yet another strain on the already overstretched health system, and further threatened the most vulnerable people in Libya. The country’s health system was struggling even before the pandemic, and COVID-19 has only exacerbated the situation. It comes on top of years of conflict in which families have seen their public services interrupted.

Thus, the outbreak of COVID-19 and its implications on not just health but the overall social contract present an important opportunity to address the interdependence of health and conflict. Health has the potential to serve as a catalyst for trust-building and enhancing broader state-society relations.

Interpeace in Libya

Interpeace’s work in Libya began in 2011. Its strategy has focused on the development of a bottom-up infrastructure for peace. Throughout the years, opportunities for bottom-up influencing of central actors and national-level dialogue processes have been limited. Libya has witnessed some very promising developments starting at the end of 2020, but this is not without its challenges: both at the central and local levels. In parallel to the national process and political developments, there is a need to strengthen social cohesion, mutual understanding, and the culture of dialogue, all of which have deeply been impacted by many years of violent conflict.

Following a ‘peace mapping’ initiative focused on understanding of the Libyan community resilience and coping mechanisms to deal with conflict, Interpeace distilled some of the factors that allowed towns to remain relatively peaceful during violent conflict. Stability remains fragile everywhere in the country, and it is vulnerable to external factors and changes in the environment: indeed, the breakdown of trust over the last ten years has deteriorated the social fabric of society. Building on this, Interpeace sought to strengthen the resilience mechanisms identified in the previous work in key areas of Libya. This was done by building a network of change agents and strengthening their capacity for community resilience and a culture of peaceful conflict resolution through the establishment of inclusive dialogue spaces. Many of the local priorities for peace identified by change agents and community members have a strong link to social service provision, in particular health.

Since 2011, the country’s already poor health infrastructure has been further weakened by ongoing conflict since 2014. This conflict between the two centres of power has led to a deterioration of health services and acute shortages of basic equipment and medicines. Indeed, health facilities have repeatedly been targeted by different armed groups. In 2020, Interpeace carried out an analysis and assessment of the impact of COVID-19 on communities in Libya, particularly looking at the impact on social cohesion and societal norms, as well as mental health. Some of the key results highlighted that the pandemic and its response stressed already weak systems of governance fueled social division, (existing) grievances and inequalities, corruption, structural macroeconomic fragilities – this interacted with pre-existing conflict dynamics and triggered multiple new needs and grievances. The narrow interpretation of the crisis and the technical health-centred responses were inadequate to address other needs and social grievances created by the virus, and indeed risked exacerbating existing conflicts. However, the results of the survey also highlighted that the pandemic offered opportunities for transforming conflict dynamics and patterns of inequality and structural violence through peace-responsive approaches (using health as an entry point), embedding trust in the response to increase its legitimacy, accountability, equity, and fairness, and have lasting effects on the relationships between individuals, communities and the state. As showcased by actions led by change agents affiliated with Interpeace, locally-led and long-term approaches allow for transformative and resilience-enhancing responses that complement existing local capacities, enable communities to build back better and build social cohesion.

Health and peace: background

Through its peace responsiveness workstream, Interpeace partners and collaborates with a number of technical agencies in multiple fields, including health, to enhance their contributions to peace. It draws attention to the imperatives created by the Sustaining Peace agenda and the notion that all actors operating in conflict-affected settings can and should contribute towards peace, and by doing so, will also increase the sustainability and effectiveness of their technical programmes. With regards to health, there is a recognition of the importance of community engagement and conflict resolution, contributing to the increased efficiency of health interventions and sustaining peace. In addition, and importantly, the lack of quality health care also contributes to the conflict and tensions by weakening the social contract, and the trust in government.

The World Health Organisation has also launched its Health and Peace Initiative, which builds on the organization’s technical competencies, relationships and convening power in health to develop innovative ways to address conflict and strengthen resilience. Peace-relevant and peace-responsive health interventions can help improve the prospects for local peace by working to improve trust and communication between citizens and the state, by making healthcare more accessible and equitable; by building collaboration between different sides in a conflict on common topics like health governance and the delivery of care; or by improving social cohesion at the local level through community healing and inclusive health promotion initiatives.

No one country has achieved the MDGs, and the global system is behind in achieving the SDGs, particularly in fragile, conflict-affected and vulnerable (FCV) settings: 1.8 billion people will not be able to achieve the SDGs and the major obstacle to this is fragility and conflict. There is no choice but to address the links of health and conflict. The COVID-19 pandemic has exacerbated this situation, and indeed has deepened the fault lines in conflict settings, as well as further eroded trust between citizens and the stage.

Interpeace generally works along three key dimensions of health and peace, including : health as an entry point for peacebuilding efforts; peacebuilding creating favourable conditions for health interventions and health as a pillar of the social contract.

Interpeace currently works with UNFPA, WHO, and FAO and in several countries to address the nexus of health and peace and has specific expertise on mental health and psycho-social support in relation to reconciliation processes.

Assignment objective

The assignment is to develop an analysis of current practices and opportunities for health and peace programming in Libya, including needs, priorities, existing policies and stakeholders (including identifying relevant partners for a health and peace initiative in Libya). The analysis and exploration should carry out a range of consultations with a multitude of key stakeholders, informed by available data sets and literature on current challenges in the health sector, policy frameworks and their gaps and opportunities for contributing to peace, the impact of the conflict on the access to healthcare, trust and perceptions towards the health system and other institutions, as well as other potential entry points for a health and peace engagement, including working on mental health and psycho-social support as it relates to reconciliation.

The focus should be on identifying entry points to promote peacebuilding and social cohesion through pillars of health, identify current practices, stakeholders, as well as potential partners for programmatic collaboration.

Specific objectives of the assignment

• Conduct a mapping of existing health interventions, actors (including identifying relevant partners for a health and peace initiative in Libya) and their approaches in Libya, understanding the health infrastructure and the policy frameworks as well.
• Conduct a mapping and analysis of: existing initiatives tackling the nexus of health and peace, potential opportunities for Interpeace to engage (with partners, both national and international). The ultimate aim is to evaluate the opportunity for joint programming on health and peace.
  • Using the WHO’s Health and Peace White Paper as framing, as well as Interpeace’s previous knowledge and analysis of the context.
• Conduct consultations with community members on local priorities for health and peace to inform programme design.
• Develop recommendations and identify specific entry points on how the intersection of health and peace programming can be operationalized in Libya, drawing on Interpeace’s presence and expertise in the country, its previous engagements and expertise on health and peace.

Main tasks

The work will consist of:

• Initial dialogue with Interpeace to receive briefing on the current health and peace programmes and practice, Interpeace’s experience in Libya and analysis of the situation.
• Review of relevant documentation related to peace and conflict analyses on Libya, health programming and stakeholders, current health and peace programming, draw out and summarise conflict and peace drivers most relevant to access to healthcare and health in general (using WHO’s Health and Peace White Paper as guidance).
• Conduct a stakeholder analysis.
• Briefing with Interpeace on proposed methodologies, as well as exploring and agreeing on the arrangements for collaboration.
• Consultations on health and peace needs and priorities with various relevant national and international stakeholders, as well as civil society organisations or platforms (e.g.: Ministry of Health, doctors’ associations, patients’ associations, WHO and other UN agencies, international NGOs, etc.), through KIIs and focus group discussions (including with Interpeace’s change agents).
• Consultations at the local level using a qualitative approach should allow for going into some to gain in-depth understanding on respondents’ perception of the health system and broader authorities.
• On the basis of these findings, identify specific opportunities for contributing to sustaining peace and develop specific recommendations for maximizing the positive impact of health-based interventions on social cohesion, or integrating health into peacebuilding programming, including identifying relevant technical partners to collaborate with. To the extent possible, include suggestions on specific technical engagement.

Deliverables

• A clearly written literature review of current health and peace programming practice in Libya and stakeholder analysis.
• A final report detailing the intersection of health and peace in Libya, current practices, needs, opportunities, as well as stakeholders and partners for health and peace engagement and programming.
• A set of recommendations for health and peace programming in Libya, including infrastructures, capacities and approaches needed to better connect the health and peace fields or to deliver peace responsive health services.
• Annex with a list of people interviewed and interview guides.

In order to best meet the aforementioned objectives, the deliverables will adhere to the following working principles:

• The report and recommendations will aim to substantively complement and draw upon rather than duplicate efforts already undertaken or in progress at other international organizations.
• The report and recommendations will be the product of a consultative and interdisciplinary process, and will be discussed amongst relevant staff at Interpeace.
• The report and recommendations will serve as an accessible and practical document for both programme design and programme implementation within Interpeace and organizations focusing on health.

The deliverables will furthermore not be limited to compilation of empirical findings but will aim to develop:

• Proposed basic integrated theoretical models and/or a set of theories of change for health and peace as they apply to the Libyan context.
• Recommendations for programme design and implementation including context and theme-specific recommendations.

Timeframe and scope

• Submission of final deliverables my mid-March 2021 at the latest. A detailed timeframe will be agreed upon at inception.

Successful candidates can complete this assignment partially from home, in frequent contact with Interpeace staff, but an element of on-the-ground exploration and participatory consultations should be included (via local partners, associations, researchers, or other).

Conduct of the assignment

The assignment will be conducted under the supervision of the Peace Responsive Programming Manager at Interpeace, with relevant technical support when needed. Interpeace’s peace responsiveness team as well as the Libya programme team will accompany the consultant(s) during the assignment.

Required qualifications for the consultant

• Postgraduate degree in peace-related studies, public health, social sciences or other relevant fields;
• Extensive experience in the analysis of peace and conflict dynamics;
• Firm understanding and background in health and/or peacebuilding;
• Good knowledge of and experience in the Libyan context, its actors, and conflict dynamics;
• Ability to work in Libya and/or interact closely with Libyan stakeholders;
• Experience in programmes related to health is a strong asset;
• Demonstrated experience in developing comprehensive and quality analytical reports;
• Demonstrated ability to take initiative and work independently with limited supervision and within established deadlines;
• Internally driven and passionate about peace and/or health;
• Excellent knowledge of peace and conflict issues;
• Excellent synthesis, analysis and writing skills;
• Ability to prepare technical publications, reports and recommendations;
• Written and spoken Arabic and English;
• Demonstrated capacity to produce quality writing in English.