• State-building agenda and health

State-building agenda and health

A significant shift has occurred recently in the orientation of U.S. foreign assistance policy. Not long ago, U.S. social sector programmes, including health, were undertaken primarily for humanitarian reasons. Today, political considerations play a much larger role. This briefing paper from USAID presents a number of topics for consideration by USAID field missions, especially those involved in the design of health sector programmes in countries that fall into the rebuilding category of the new foreign assistance framework.

The authors focus on providing support to the development of a strong policy framework, typified by a basic package of health services and the provision of long-term technical assistance to the central and especially the intermediate levels of a health system. The document also recommends the development of a system of health care provision that is characterised by public sector management of private sector implementation. The brief concludes that in fragile states, both the provision of humanitarian assistance to war-weary populations and political assistance to new governments that are attempting to establish legitimacy and effective governance are U.S. foreign assistance objectives. This two-track approach creates problems for health officers. They argue that the importance of harmonising donor assistance cannot be overemphasised. If new governments are paralysed by competing, and often conflicting, donor programmes, no one programme’s objectives can be achieved.

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