Recommended readings
Absorptive capacity of health systems in fragile states
Supporting the health sector in fragile states
Authors:
L. Tayler
Publisher:
HLSP Institute, UK, 2005
What can donors do for the health sector in fragile states? This paper from the HLSP Institute outlines some principles and approaches that can help to address absorptive capacity constraints, and to support long term development of health systems. It begins by looking at the broad context and at the multiple challenges (political, economic and practical) faced by donors. Moving to the health sector, the paper highlights the key issues and offers ideas and suggestions for donor engagement. The author shows how the design and approach to monitoring a programme should depend upon whether the first priority of a donor is to improve health outcomes, strengthen the health system, or catalyse broader societal change. Wherever possible donors should support the core stewardship functions, helping national governments to lead the development of a coherent and realistic health strategy, and to co-ordinate the various stakeholders. This is particularly important given the range of actors and instruments working in health, with overlapping and competing agendas.
The author argues that it is important to think ahead and use evidence emerging from countries that have recovered from conflict and from other low income countries to develop approaches that reflect current thinking, rather than just try and rebuild what worked in the past. In particular, this means recognising that a major source of finance for the health sector is likely to be out of pocket, and that much of the delivery will be by the private sector. Whilst most donors have adopted a lower risk strategy of minimal engagement in fragile states, and have channeled most of their assistance through NGOs where they do engage, there have been successful exceptions. The unprecedented volumes of aid that are being allocated to health, and the escalation in the quality and quantity of analysis around investment in fragile states, mean that there are opportunities for major progress if these two forces can be brought together and translated into strategic action.
