Overview: health systems in fragile states

There are two main approaches to health services delivery in fragile states: the humanitarian approach and a more developmental approach, these days often labelled as 'health system strenghthening'. In the humanitarian approach saving lives comes first, and humanitarian principles of humanity, impartiality and neutrality may be at odds with providing health services under a government umbrella. A key feature of health system strengthening is to get the government and its Ministry of Health back in the driver's seat, taking charge of health policy setting, monitoring and regulation. Which approach is taken depends on donor views on whether it appears to be possible to strengthen a country’s health system, or whether there is a need to focus on humanitarian delivery of services. Both approaches need to take into account the often profound governance problems that exist in fragile states.

Increasingly there are overlaps between the two approaches. The benefits of supporting health systems as a whole in fragile states - rather than focusing on disease specific vertical interventions or humanitarian interventions that are often limited in scope, sustainability and coverage - are increasingly recognised. The literature around early recovery indicates that many aid and donor agencies are now working on some middle ground. They are starting to think and act more on health systems strengthening in an early recovery phase, where historically the focus had purely been on humanitarian interventions. There is now increased attention for building institutions and capacity at the individual, organisational and societal level, although on the whole the humanitarian and health systems strengthening approaches are quite distinct in terms of how they are funded and implemented.