Health system reconstruction: can it contribute to state-building?

There is a growing knowledge base demonstrating the importance of good governance in the health sector for effective health systems and improved service delivery. This study commissioned by the Health and Fragile States Network, explores the interactions between health sector strengthening and state-building. The authors examine this through various interviews, a literature review and two case studies: Nigeria and Sierra Leone. The hypothesis for the paper is that building health systems contributes to wider state-building by  helping to strengthen state capacity and by signalling the increased willingness of  the state to act on behalf of citizens in a responsive and accountable manner.

The authors find that health sector strengthening can contribute to state building in the health sector. It can help build legitimacy and capacity, and put health on the state-building agenda. It is argued that the impact of health sector interventions on wider state-building is unclear. There may be more scope for wider state-building and strengthening the state-society compact through decentralised and ‘bottom up’ approaches.