Redesigning humanitarian health interventions: A framework for sustainable integration with local systems

The current humanitarian health model frequently, though not universally, establishes temporary parallel systems that undermine local public health infrastructure through brain drain, bypassing local supply chains, and creating data silos, ultimately leaving systems vulnerable post-aid withdrawal. This tendency is most pronounced in sudden-onset disasters and high-visibility emergencies, yet even in protracted crises where humanitarian actors work within existing Ministry of Health structures, poor coordination and absent integration accountability mechanisms perpetuate fragmentation. This viewpoint proposes a transformative approach to humanitarian interventions by mandating a Health System Integration Plan as a prerequisite for funding. This plan prioritizes integration with local staff, procurement, and data systems from the outset, ensuring flexibility to adapt to diverse crisis contexts, reinforcing existing structures in post-disaster settings and rebuilding through community-based strategies in fragile states. It balances immediate life-saving needs with long-term resilience across acute, stable, and recovery phases, embedding integration strategies from day one. Practical guidance for humanitarian actors includes co-designing plans with local stakeholders, transitioning to mentorship roles, and adopting integration-specific metrics for monitoring and evaluation. Aligned with the Humanitarian-Development-Peace (HDP) nexus, this framework leverages multi-sectoral partnerships and flexible funding to enhance feasibility, particularly in conflict-affected regions.