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Health governance in fragile states

Health governance in fragile states. Lessons from early recovery fragile states…. Laurie Zivetz, MPH, PhD. Elements of state building. STATE. Legitimacy. Effectiveness. Compact/Policies. Civil Society/Voice. Health Systems. Consumers. Marketplace.

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Health governance in fragile states

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  1. Health governance in fragile states Lessons from early recovery fragile states…. Laurie Zivetz, MPH, PhD

  2. Elements of state building STATE Legitimacy Effectiveness Compact/Policies Civil Society/Voice Health Systems Consumers Marketplace Adapted from World Development Report, World Bank 2004.

  3. Assumptions: • Effectiveness + legitimacy = governance • Development assistance can have greater impact on effectiveness • Stewardship begins with a regulatory role

  4. State Clients Providers Humanitarian Agencies 1. Post conflict humanitarian assistance circumvents the state

  5. 2. External resource flows out of sync with absorptive capacity; planning frameworks

  6. 3. Emergence of “two tracks” • Relief bureaucracies stay too long, or morph into rebuilding functions • Non state actors control disproportionate resources • Talent, decisionmaking gravitates to resources

  7. Why do rebuilding efforts rely on non state actors? • Accountability and capacity concerns • Political considerations

  8. 4a. Rebuilding efforts benefit from coordination Coordination and planning Rand, 2006

  9. KEY:TA = Technical Assistance$ = FundingTrng = Training TA $ $ TA TA State: Politicians and policymakers $ /TA Trng Trng/TA TA TA Information and reporting $ / Trng Trng Client power Providers Clients/Citizens TA Trng 4b. Fragmentation overwhelms already fragile states

  10. 5. Leaving too soon Staying for a long time does not always guarantee success; leaving early assures failure.

  11. Supporting state stewardship in health • A common donor framework for planning and action • A lead actor • Funding mechanisms that support a coherent, state-led approach • Donor alignment with government systems • Realistic, reliable aid flows

  12. 6. Standing the model on its head: Reciprocal accountabilities to build governance Recipient state Responsiveness/reporting Voice/compact Aid agencies Donor state

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