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Fragile States

Health Systems 20/20 is engaging in work with USAID missions and other partners to support reconstruction and development in post conflict or otherwise fragile states.

Challenge

Strengthening health systems to deliver services in fragile and post-conflict states is an undertaking filled with difficult problems and trade-offs. Service delivery capacity in such settings is weak and in the case of countries that have experienced violence and conflict, is often debilitated and destroyed. Assuming the stewardship role of a Ministry of Health, and identifying the priority steps to assure that the population has access to key health interventions are the first challenges confronting a new government that assumes leadership of the health sector after a conflict.

NGOs in the country that have been providing humanitarian relief during the crisis represent both a challenge and an opportunity. They are either forced to transition from relative autonomy to sharing control with a central government or they depart the country post conflict and leave segments of the population without access to services. Other challenges include issues such as: integration of former combatants, greater burden of mental health disease, destruction of the social fabric upon which many community health interventions are built, persistent political struggles that delay establishing health policy, weak management and technical skills, inadequate information about the sector, weak operational systems, inadequate (damaged) infrastructure, and the proliferation of donors with diverse agendas without a strong Ministry of Health counterpart.

Key questions include:

  • What are the first steps a country should take after a conflict and what should responsible donors and NGO partners do to help the health system evolve from conflict/fragile to a more stable situation?
  • How can capacity be rebuilt or created in a manner that avoids dependency and is sustainable?
  • What rules and practices should be established to build the public's confidence and trust in the ability of the reconstituted Ministry of Health and other social welfare institutions to respond fairly and equitably to people’s health service requirements?

Approach

Health Systems 20/20 seeks to work with Missions and their country partners to deal with the particular challenges faced by fragile and post-conflict states in rebuilding their health systems. The project tailors interventions to the characteristics of the health system along the fragile-to-graduating continuum. Download a table providing illustrations of Customized Solutions for Fragile States.

Health Systems 20/20 is providing some support to USAID in preparing tools and identifying best practices to guide donor, government, and other development partner actions in post-conflict situations and fragile states that contribute to developing a strong health system. Among the products to date are: 1) a template for NGO grants that encourages explicit attention to systems strengthening in the context of post-conflict relief efforts, and 2) presentations on performance-based financing in fragile states and on health systems strengthening in fragile states. Further analytic and field support activities are planned for the future.

Please see the information below for links to Health Systems 20/20 documents and presentations on the topic of governance and development in fragile states.