This study assessed formal and informal networks involved in public health response during Florida's devastating 2004 hurricane season. Researchers conducted interviews with response participants to identify relationships between formal and informal healthcare networks at the local level and how these networks functioned and communicated. Preliminary results found that strong leadership, relationship building, and addressing logistical challenges were important. Volunteers were also instrumental in response, either as spontaneous, unaffiliated aid or through becoming affiliated with formal groups. Future research directions included further exploration of how informal networks emerge and fill response gaps as well as assessing current understanding and "lessons learned" regarding informal network surge capacity.

1. An Assessment of Formal and Informal Networks Across Public Health ResponseAn 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.
IntroductionIntroduction
Goals and ObjectivesGoals and Objectives
Review of the LiteratureReview of the Literature
MethodsMethods
Preliminary ResultsPreliminary 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 Biological
Defense 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 future
coordination.
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 DirectionsFuture 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