Delivering health services in fragile states

Governments in fragile states are, by definition, unable or unwilling to deliver core services to their entire population. Human, material and financial resources for the implementation of health services are limited. Qualified health workers have left the country, infrastructure and equipment are destroyed or poorly maintained, and aid money is the primary source of funding public services.

Populations in fragile states suffer a significantly higher burden of disease and mortality. A large proportion of the population lives in rural areas with poor infrastructure in terms of access, water and sanitation, and high rates of illiteracy. This poses additional challenges to health services delivery in these states, where poverty levels are also high, with families often living on less than US$1 per person per day. Illness therefore results in a significant financial burden as a result of missed work opportunities and payments for transport, consultancy fees, and medicines.

The videos on the website Gapminder.org (see link below) give an idea of how health systems, poverty and health outcomes are intrinsically linked. A careful examination of the relative positions of the fragile states indicates that they chronically exhibit the poorest health outcomes.

This section outlines two approaches to health services delivery in fragile states: the humanitarian approach, which focuses on meeting the immediate health needs of a population, and the health systems strengthening approach, where the focus lies on capacity building of the government in its role as steward of the health system. The design of aid instruments and the structure of donor aid bureaucracies reflect and reinforce these two approaches, but increasingly donors and NGOs are seeking to find a more integrated set of programmes that link immediate services with building capacity.