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Non-state providers, the state, and health in post-conflict fragile states
Abstract
Relations between states and non-state providers in fragile states occur within specific complex political and economic contexts. Moreover, donor approaches to specific fragile states shape the flow and priorities of aid resources. In the health sector, fragile states have dramatically poor health outcomes, with higher mortality and morbidity rates than other low-income, relatively stable states. Les prestataires non publics, l'État et la santé dans les États fragiles post-conflit Les relations entre prestataires publics et non publics dans les États fragiles ont lieu dans le cadre de contextes politiques et économiques complexes précis. De plus, les approches des bailleurs de fonds concernant les États fragiles influencent le flux et les priorités des ressources d'aide. Dans le secteur de la santé, les États fragiles affichent des résultats extrêmement mauvais en matière de santé, avec des taux de mortalité et de morbidité supérieurs à ceux d'autres pays à faible revenu relativement stables. Provedores não-estatais, o estado e a saúde em estados frágeis após conflito As relações entre provedores estatais e não-estatais em estados frágeis ocorrem dentro de contextos políticos e econômicos complexos específicos. Além disto, abordagens de doadores para estados frágeis específicos influenciam o fluxo e as prioridades dos recursos de ajuda. No setor da saúde, estados frágeis apresentam resultados de saúde incrivelmente ruins, com taxas de mortalidade e morbidade maiores do que outros países relativamente estáveis de baixa renda. Proveedores no estatales, el Estado y la salud en Estados frágiles durante el posconflicto Las relaciones entre el Estado y los proveedores no estatales se dan en contextos políticos y económicos especialmente complejos en Estados frágiles. Además, en ciertos Estados frágiles son los donantes quienes diseñan las estrategias que establecen el flujo y las prioridades de los recursos humanitarios. En el sector salud, los Estados frágiles tienen los indicadores más negativos, con tasas de mortalidad y morbilidad más altas que en Estados de bajos ingresos pero relativamente más estables.
... Most conflicts occur in resource-limited settings in the context of an already under-resourced health sector [6,7]. During conflict, systemic weaknesses are exacerbated and critical health needs arise [8,9]. Many states are at risk of future violence, which undermines confidence in efforts to rebuild a health care system [9]. ...
... During conflict, systemic weaknesses are exacerbated and critical health needs arise [8,9]. Many states are at risk of future violence, which undermines confidence in efforts to rebuild a health care system [9]. However, state legitimacy can be enhanced during the transition to peace if provision of a range of basic services, including primary care, can be secured. ...
... Quality control mechanisms governed by an effective administration enable regulation of drug-prescribing practices [7]. 9 ...
Objective:
Conflict is often destructive to existing services and exacerbates population health inequities and the vulner-abilities of existing healthcare. We undertook a scoping review of the literature concerning delivery of primary healthcare (PHC) in post-conflict settings.
Design:
We undertook a scoping review of the peer-reviewed and gray literature to identify articles related to the development and delivery of PHC in post-conflict settings. We searched PubMed/Medline, Cochrane Library, Em-base/Ovid, CAB abstracts, POPLINE, and WHO.int. between January 1990 through the December end of 2017, for arti-cles in the English language. Two researchers independently assessed each article and applied inclusion criteria: refer-ring to post-conflict settings and a range of terms related to PHC or health system development. Search terms were selected by careful review of the World Health Organization's analytical framework for developing a strategy on univer-sal coverage and analysis according to the availability, accessibility, affordability, and acceptability of healthcare and further themes involving demand-side or user-side concerns.
Results:
Findings were captured to reflect a range of conflict-affected settings and varied priorities and approaches to PHC reconstruction. Integrated immediate and longer-term strategies, involving needs-assessments, effective ad-ministration, development of institutions, and cost-efficient investment in human resources, infrastructure, and capacity building are needed to deliver expanded and equitable services, responsive to population health needs, critical to the delivery of equitable PHC.
Conclusions:
Scoping review of the literature may be formative in the generation of evidence-base to inform delivery of universal PHC, when applied according to context specificity of conflict-affected setting.
... These define the challenges for health system development or strengthening. Effectively, fragile states face the same challenges as all resource-constrained contexts, only to a greater degree (Canavan & Swai, 2008;Commins, 2010). Health financing has to be considered in the context of its inter-linkage with other health system building blocks. ...
... Contracts for services to non-state actors may produce shortterm benefits in terms of enhanced service delivery, but there are problems in terms of building sustainable service-delivery systems for the long term. This 'two-track problem' poses a real dilemma between mitigating immediate humanitarian needs and delaying the establishment of durable, local service delivery (Commins, 2010). However, the problem may lie not so much with non-state actors operating separately from state agencies, but rather in the lack of any overall policy or coordination framework, both among donors themselves, and among donors, governments, and nonstate actors. ...
... It is in these contexts that everyday lived experiences of violence undermine the confidence of citizens in government systems, directly and indirectly have a negative impact on livelihoods, and frequently reduce the quality and quantity of service provision. Though these impacts are varied and often characterised as hyper-local, they do collectively shape wider discussions on governance and state fragility at the national scale (Commins 2010). ...
How will security in cities be understood in the future? For whom will it be provided? What are the ways by which urban security provision will be governed? And, what impact will violence and order in cities have on the processes of state-building in fragile contexts in the future? This article reports on a foresight study that addresses these questions. A key finding is that there are multiple and overlapping forms of urban violence, and the ways these interact have important consequences for understanding order in future cities.
... It is in these contexts that everyday lived experiences of violence undermine the confidence of citizens in government systems directly, indirectly have a negative impact on livelihoods, and frequently reduces the quality and quantity of service provision (for example, across urban Maharashtra riot victimisation is positively associated with economic vulnerability and weak social interactions, as found by Gupte, Justino and Tranchant 2014). Though these impacts are varied and often characterised as hyper-local, they do collectively shape wider discussions on governance and state fragility at the national scale (Commins 2010). ...
Over a 50-year span, Institute of Development Studies (IDS) research has not focused on cities or urbanisation to the extent it might have. We find that there is good reason for cities to now be described as the ‘new frontier’ for international development. In particular, violence is increasingly a defining characteristic of urban living in both conflict and non-conflict settings. This has important consequences for the relatively under-researched links between urban violence, the processes of state building, and wider development goals. Benefiting from key IDS contributions to the debates on the security–development nexus, citizenship and the hybrid nature of the governance landscape, we argue that the moment is opportune for the Institute to deepen its research and policy expertise on urban violence ‘in the vernacular’.
The objective of this work is to establish a relationship between the realization, in the geopolitical and existential space of the city, of some Sustainable Development Goals (SDGs) set by Agenda 2030, as a political alternative for mitigating violence and, consequently, for the realization of the right to a safe city. The essay starts from the assumption that the main place where violence occurs is the city and, therefore, it is from there that the diagnosis of the phenomenon and the planning and execution of public policies to soften violent encounters/relationships should be made. The SDGs, in this sense, with their targets and indicators, should be taken as benchmarks for such purposes. The methodology used was double: the phenomenological method, to reveal some aspects and characteristics of the contemporary phenomenon of violence, especially the fact of its manifestation in the city space; and the hypothetical-deductive method, because it started from some generic statements related to the SDGs for the construction of some more specific reflections related to the right to a safe city. The work is expected to propose new lines of reflection and investigation on the mitigation of violence for the implementation of the SDGs in the city and the realization of the right to a safe city.
KEYWORDS:
Violence; Mitigation; SDGs; Public policy; Right to a safe city
Whereas there is a consensus on the significance of rebuilding conflict-torn states and societies, there is no agreement on how it should be done. The dominant framework of post-war rebuilding is clearly biased to rebuilding the ‘hardware’. This article argues that the government’s attempt to rebuild the Rwenzori sub-region in the aftermath of the Allied Democratic Forces war adopted the conventional approach that pays less attention to rebuilding ‘software’. It further asserts that the recovery programme was symbolic given that government wished to avoid the political consequences of not taking action at all. Symbolism not only led to flawed performance of the recovery programme but also negatively affected peace building in the sub-region. The article advocates not only for a synergy of rebuilding ‘hardware’ and ‘software’ but also for a nuanced approach that triangulates top-down and bottom-up approaches at all stages of post-conflict recovery.
This article analyses the dire state of the health system in war-torn Syria. It investigates the drastic changes that have transpired in health provisions since the beginning of the conflict and sheds light on emerging coping mechanisms. The article traces the militarisation of medical care and outlines the severe imbalances created in the provision of medical aid between different parts of the country. Independent of the political or military outcome of the present war, this article recommends an integrative approach towards health system recovery which is primarily anchored in the experience of those who continue to maintain medical care across the country.
How will security in cities be understood in the future? For whom will it be provided? What are the ways by which urban security provision will be governed? And, what impact will violence and order in cities have on the processes of state-building in fragile contexts in the future? These questions are uppermost in the minds of policymakers and academics.
A growing body of evidence underlines the heterogeneity of security processes and outcomes, both within and between cities. Notwithstanding these recent advances, contemporary paradigms of urban development do not substantively account for the ways in which the social, political, economic and physical aspects of urban form interact and shape the mechanics of security provision in cities. There is a perceptible gap in development policy, compromising the manner in which international donors, multilateral agencies, national and sub-national policymakers respond to urban challenges today. Part of this gap is due to the separation between development theory or urban planning, and issues of fragility due to conflict and violence. These have usually been different epistemic and operational domains, to the detriment of either a comprehensive approach to analysing fragility and violence or effective approaches to security provision.
This paper analyses equity in health and healthcare utilization in Afghanistan based on a representative national household survey. Equitable access is a cornerstone of the Afghan health policy. We measured socioeconomic-related equity in access to public health care, using disability--because people with disabilities are poorer and more likely to use health care--and a concentration index (CI) and its decomposition. The socioeconomic-related equity in healthcare utilization was measured using a probit model and compared with an OLS model providing the horizontal inequity index (HI). We found a low rate of healthcare facilities utilization (25%). Disabled persons are using more healthcare facilities and have higher medical expenses. Disability is more frequently associated with older age, unemployed heads of household and lower education. The Cl of disability is 0.0221 indicating a pro-rich distribution of health. This pro-rich effect is higher in small households (CI decreases with size of the household, -0.0048) and safe (0.0059) areas. The CI of healthcare utilization is -0.0159 indicating a slightly pro-poor distribution of healthcare utilization but, overall, there is no difference in healthcare utilization by wealth status. Our study does not show major socioeconomic related inequity in disability and healthcare utilization in Afghanistan. This is due to the extreme and pervasive poverty found in Afghanistan. The absence of inequity in health access is explained by the uniform poverty of the population and the difficulty of accessing BPHS facilities (a basic package of health services), despite alarming health indicators.
Post-Conflict Health Sectors: The Myth and Reality of Transitional Funding Gaps', [London]: Health and Fragile States Network, and
- References Canavan
- Petra Ann
- Olga Vergeer
- Jacob Bornemisza
- Nadine Hughes
- Ezard
References Canavan, Ann, Petra Vergeer, and Olga Bornemisza, with Jacob Hughes and Nadine Ezard (2008) 'Post-Conflict Health Sectors: The Myth and Reality of Transitional Funding Gaps', [London]: Health and Fragile States Network, and [Amsterdam]: Royal Tropical Institute.
Synthesis Paper on Good Practice: the Challenge for Donor
- S Commins
Commins, S. (2006) 'Synthesis Paper on Good Practice: the Challenge for Donor', [Paris]: OECD/DAC Workstream on Service Delivery.
Treading a Delicate Path: NGOs in Fragile States". London: Save the Children UK
- S Commins
Commins, S. (2007) 'Treading a Delicate Path: NGOs in Fragile States', draft report, London: Save the Children UK. DFID (2005) Why We Need to Work Effectively in Fragile States, London: DFID.
Health System Reconstruction: Can it Contribute to State-building?
- J Eldon
- C Waddington
- Y Hadi
Eldon, J., C. Waddington, and Y. Hadi (2008) Health System Reconstruction: Can it Contribute to State-building?, London: HLSP Institute, for the Health and Fragile States Network.
Treading a Delicate Path: NGOs in Fragile States – Case Study Southern Sudan', draft report
- W Fenton
Fenton, W. (2007a) 'Treading a Delicate Path: NGOs in Fragile States – Case Study Southern Sudan', draft report, London: Save the Children UK.
Health Programming in Post-Conflict Fragile States
- R Waldman
Waldman, R. (2006) Health Programming in Post-Conflict Fragile States, Arlington, VA: BASICS, for USAID.
Health Service Delivery in Early Recovery Fragile States: Lessons from Afghanistan
- L Zivetz
Treading a Delicate Path: NGOs in Fragile States - Case Study Southern Sudan”. London: Save the Children UK. draft report
- W Fenton
Post-Conflict Health Sectors: The Myth and Reality of Transitional Funding Gaps
- Ann Canavan
- Petra Vergeer
- Olga Bornemisza
- Jacob Hughes
- Nadine Ezard
Treading a Delicate Path: NGOs in Fragile States - Case Study Afghanistan
- W Fenton
Achieving the Health Millennium Development Goals in Fragile States
- Hlf