An Assessment of Formal and Informal Networks Across Public Health Response An Assessment of Formal and Informal Networks Across Public Health Response Networks: A look at Florida's 2004 Hurricane SeasonNetworks: A look at Florida's 2004 Hurricane Season

Beverly Hill, M.Ed., Jaime Corvin, PhD, Darcy Ravndal, MPH, Jordan Nelms, Brian Cull, Jacqueline Cattani, PhD

By most standards, the 2004 hurricane season was the most devastating in Florida’s history. Four hurricanes crossed the state in five weeks, causing 47 deaths and costing nearly $50 billion in damage. Most parts of the state were affected by at least one of the storms; many places were hit by two or three. Nearly 1.7 million people were forced to evacuate at some point; response was difficult due to the ongoing nature of the natural disaster.

To achieve our objectives and generate research findings that can be utilized for policy prescriptions, this project consists of both 1) a review of the current body of knowledge and existing policies and 2) a qualitative research component. Review of the literature and existing policies includes an extensive review of the literature on issues pertaining to formal and informal networks through an interdisciplinary lens, including anthropology, public health, and political science. The research component of this project utilizes qualitative methodologies to assess the role of formal and information networks in disaster recovery.  Data will be collected through in-depth semi-structured interviews with persons active in the relief efforts following the 2004 hurricane season.

Introduction

Goals and Objectives

Review of the Literature

Methods

Preliminary Results

The purpose of this study is to conduct an assessment of the role of the formal and informal public health networks, as they were instrumental in disaster response during the 2004 Florida hurricane season. Evaluation of the current role of these networks may serve as a useful model in the development of standardized tools and continuing education and training efforts, both locally and nationally.

Goals of the project are:

1. Identification of formal and informal networks across public health response efforts, as was seen throughout Florida’s 2004 hurricane season.

2. Describe how these networks emerged and how these relationships currently function.

3. Assess the needs of these networks for effective communication and coordination.

Specific objectives for the University of South Florida Center for BiologicalDefense study are as follows:

1. Identify relationships between formal and informal healthcare and public health-related emergency response networks at a local level;

2. Define the associations between these networks;

3. Develop standardized tools to assist organizations with futurecoordination.

Although different in size and scope than hurricane Katrina in 2005, there are many parallels to the difficulties faced by those involved in recovery efforts in both circumstances. Both disasters saw the emergence of new and/or expanded roles for both formal and informal public health response, particularly at the local level, and the integration of these networks as part of standard mitigation efforts.

Emergent themes from interviews with community representatives of local disaster response networks include:

Strong leadership: Participants discussed the need for effective leadership as the only way to develop an informal disaster recovery group from the ground up.  As with any collaboration, effective leadership is necessary to achieve cohesion among groups.  Local governments do not seem to have taken the lead in this charge.  Rather, national humanitarian organizations such as the United Way and The Red Cross have developed local offices for disaster recovery, and take it upon themselves to build these collaborative groups.  The government does play a significant role in the education of planning and preparedness, but the actual buildup and organization of informal disaster recovery groups comes from the organizations that are providing services directly to the affected community.

Relationship building: Participants discussed the importance of building relationships prior to the activation of disaster recovery services.  Whether between individual humanitarian organizations or between local recovery networks (long term recovery committees, COAD/VOADs, volunteer management programs), knowing who you will be interacting with reduces barriers to providing services to affected individuals and communities.  Building relationships also helps to prevent the duplication of disaster recovery services.  When multiple organizations provide similar services, interacting within the framework of recovery networks helps to identify duplication, enabling organizations to work together rather than unknowingly compete. 

Logistics: Another area of concern for some of the interviewees is the need for improved logistics, which is also confounded by the unpredictable migration patterns of populations affected by catastrophic events. As a result, it is often during the immediate response phase that informal networks emerge. This is particularly true when an emergency response system has been deployed and is operating in a situation of surge – when needs are at their highest and capacity across the local formal network is reduced. In some cases, it is through informal networks within the formal system that progress is achieved. Consequently, bureaucratic constraints can sometimes be overcome by the fundamental relationships that exist among key actors in the process of disaster response, while in some cases the opposite is true, and bureaucracy constrains those relationships.

The instrumentality of volunteers: Volunteers have been identified in most interviews as spontaneous, unaffiliated, or affiliated. The groups that have experienced the greatest success appear to be those that have found ways to transform a base of volunteers that emerged as spontaneous and unaffiliated to any particular group to an affiliation within the formalized network, thus transferring the network from an informal state to a more formal state. This seems to happen through several routes: enhanced communications, information sharing, and speaking with a unified voice.

Religious considerations: Many humanitarian organizations providing disaster recovery services that operate within informal recovery networks have a mission founded in religion.  When they descend upon an affected community, an additional aspect of their operations (whether intentional or unintentional) includes missionary work.  This has the possibility of leading to competition amongst the various religious organizations.  While faith can certainly strengthen a person’s resolve during the stress of dealing with a disaster, the interaction between providing recovery services and missionary work can cause conflict within an informal recovery group. 

Preparedness: The development of informal disaster recovery groups takes a significant amount of time and effort.  A great deal of communication and coordination for which pathways must be created are required for these groups to be able to operate. There is a strenuous learning curve that takes place because there is very little in the way of formal training materials, other than academic literature (which many of the groups interviewed do not have access to). Comprehensive informal network building plans should be publicly available and easily accessible.

Future Directions We are continuing to explore the points at which informal networks emerge, how informal networks turn

formal through conscious acts of communication, collaboration and coordination, and how informal networks fill in gaps when formal networks are unable to meet local needs by:

Throughout the literature there areaccounts of emergent groups that have formed specifically to fulfill an unmet need in disaster response, in the scope of both natural and man-made events (Allen 2006, Delica 1993, Kilby 2007, Leivesley 1977), although many of these groups have emerged from within, or in response to, non-governmental action around a specific hazard. Only in the past couple decades have informal networks like these begun to garner more interest, as they are mostly ephemeral, not well understood, and disconnected from the whole. With the knowledge that the public increasingly expects better public sector leadership before, during and after catastrophic disasters than it has in the past, and that preparedness for catastrophic disasters requires a much greater level of resources and training for events that may never occur (Kapucu & Van Wart, 2006), the entire nation’s response capabilities would be tremendously enhanced if formal networks were able to harness and bring cohesion to the immense potential capacity represented by informal community networks. Moreover, the influence of informal networks as conduits of the shifting of knowledge and restructuring of methods of governance is proposed as being critical to the success of meeting the needs of local citizens at a time when surge capacity is extraordinary and times of crisis are high.

While the term “surge capacity” is often restricted to health systems and their ability to absorb large numbers of additional patients (Kelen and McCarthy, 2006), in this particular case we will intentionally expand the connotation of surge capacity to refer to the entire disaster response system’s elasticity to respond to the effects of a high consequence event. Formal networks have embedded surge responses within their plans, while response to potential surge within “informal network” communities can provide opportunities for the demonstration of resiliency despite vulnerability within and among social networks at the local level, through their social cohesion. Furthermore, studies on social cohesion demonstrate that research on social networks should begin to more clearly specify the social processes in networks that influence individuals’ attitudes and behaviors (Friedkin, 2004). Since social cohesion is naturally a factor in research on social networks, we also hope to accomplish this goal through the study of informal networks in the context of disaster response at the local level, paying particular attention to groups that assert their autonomy from their greater community, through networks.

Photo provided courtesy of Graham Tobin, Ph.D., USF Department of Geography

• Assessing the current work from academia, government, the private sector and NGOs regarding ‘informal network’ surge response to disasters, including “lessons learned” through a state and local response analysis.

• Identifying informal networks of citizen, FBO, CBO and business-based surge capacity for disaster response.

• Compiling qualitative data via meetings/interviews with state and local healthcare (as well as other miscellaneous) organizations involved in disaster preparation and response efforts.

Figure 1. Sampling Frame

Organization Type

Leaders/Directors/Managers

Paid Staff Volunteers Totals

Government Agencies

5 5 5 15

Formal voluntary organizations (CBOs, FBOs, NGOs)

5 5 5 15

Informal voluntary groups

5 5 5 15

Totals 15 15 15 45

* All sample sizes are minimum. Sampling will continue until saturation has been reached.

Photo provided courtesy of Graham Tobin, Ph.D., USF Department of Geography