Health and the governance agenda

There are increasing attempts to link development aid with the need for improved stability and security at the national, regional and international levels. Building resilient and responsive states in fragile environments is central to this agenda. This state-building agenda is encapsulated in one of the OECD’s Principles for Good International Engagement in Fragile States, which suggests that focusing on state-building is a new central objective for the aid community. However, there is very little knowledge about how to ‘do’ effective state-building. Common state-building initiatives include state capacity building, security sector reform, justice sector reform, community driven development and basic services delivery, including health. State-building is an endogenous process, and external actors cannot ‘do’ state-building. They can, however, provide incentives that affect how national processes work. The role of the health sector in the state-building and governance agenda is uncertain at this point, and needs further exploration.