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Published byJayden Watkins Modified over 11 years ago
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Health governance in fragile states Lessons from early recovery fragile states…. Laurie Zivetz, MPH, PhD
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STATE LegitimacyEffectiveness Compact/Policies Health Systems Consumers Marketplace Adapted from World Development Report, World Bank 2004. Civil Society/Voice Elements of state building
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Assumptions: 1.Effectiveness + legitimacy = governance 2.Development assistance can have greater impact on effectiveness 3.Stewardship begins with a regulatory role
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ClientsProviders Humanitarian Agencies State 1. Post conflict humanitarian assistance circumvents the state
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2. External resource flows out of sync with absorptive capacity; planning frameworks
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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
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Why do rebuilding efforts rely on non state actors? 1.Accountability and capacity concerns 2.Political considerations
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4a. Rebuilding efforts benefit from coordination Coordination and planning Rand, 2006
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Compact Voice Services Responsiveness TA $ Trng Providers Information and reporting Clients/Citizens Client power State: Politicians and policymakers TA Trng TA $ / Trng Trng Trng/TA Trng $ / TA TA $ $ KEY: TA=Technical Assistance $=Funding Trng=Training 4b. Fragmentation overwhelms already fragile states
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5. Leaving too soon Staying for a long time does not always guarantee success; leaving early assures failure.
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Supporting state stewardship in health 1.A common donor framework for planning and action 2.A lead actor 3.Funding mechanisms that support a coherent, state-led approach 4.Donor alignment with government systems 5.Realistic, reliable aid flows
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Directives/oversight Resources and reporting Responsiveness/reporting Voice/compact Aid agencies Recipient state Responsiveness/reporting Donor state 6. Standing the model on its head: Reciprocal accountabilities to build governance
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