Commissioned by the Health and Fragile States Network, June 2009
Strengthening health systems in fragile states is often challenging given the limited resources available, problems of governance, and the difficulties of organizing and delivering health care in these often conflict-affected settings. Despite these challenges, there has been increasing focus on strengthening health systems as fragile states have a high burden of ill health, and are currently off-track to meet the health millennium development goals (MDGs) (WorldBank 2007). Poor health systems are considered to be a major constraint to improving health outcomes, resulting in increased efforts by the global health community to strengthen health systems. Health system strengthening (HSS) has been defined as improving the ‘six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes. It requires both technical and political knowledge and action.’ (WHO 2007). HSS includes capacity building and other initiatives to improve the leadership, management and financing of health systems, as well as strengthening of human resources, health information and medical and drug supply systems.
Overall, the report aims to shed light on whether international and local health actors can ‘do’ health system strengthening in various types of fragile states, where governance and institutions are weak, and resources limited. It is directed at policy-makers, donors, and field staff working to deliver health and strengthen nascent or weak health systems. Although the initial aim of the report was to include only submissions referring to externally evaluated projects or programmes, it was decided to also include submissions that describe ideas or concepts that have not yet been (fully) implemented, evaluated or tested. This was done in order to inspire new ideas and innovations for health services delivery in fragile states, which in future versions of this report could be evaluated and included as “good practice”. This reflects the Health and Fragile States Network’s aim to stimulate debate, documentation and research on health issues (see www.healthandfragilestates.org for more information). As such, the Network welcomes further submissions or updates to this report as well as feedback regarding experience with these or other strategies and the results obtained.