Thus it could be argued that weak service delivery is a function of poverty and low levels of development rather than of the fragility or failure of the state per se.
This table, from a 2010 paper by Frances Stewart and Graham Brown, at Oxford’s Centre for Research on Inequity, Human Security and Ethnicity, uses World Bank indicators data (2005) to establish thresholds that categorize when service delivery weaknesses place the state at increasing risk of failure.Paper available at: http://www.crise.ox.ac.uk/pubs/OV3.pdf
From the same Stewart and Brown (2010) paper, here are their rankings for the three countries we will hear about today.According to the World Bank’s classification, all three countries fall into the fragile category.
Source: Brinkerhoff, Derick W. “From Humanitarian and Post-conflict Assistance to Health Systems Strengthening: Clarifying the Transition and the Role of NGOs.” Health Systems 20/20, Policy Brief, October 2008.
So, in short, health service delivery needs to accomplished in ways that contribute to state-building.Important to recognize that some external interventions to provide health services are intended solely to meet immediate health needs.
better systems, better health Health Systems Strengthening in Fragile and Conflict-affected States: Introduction Better Health Systems: Strategies that Work Presentation Series at the Global Health Council Derick W. Brinkerhoff February 7, 2012Abt Associates Inc.In collaboration with:I Aga Khan Foundation I Bitrán y AsociadosI BRAC University I Broad Branch AssociatesI Deloitte Consulting, LLP I Forum One CommunicationsI RTI International I Training Resources GroupI Tulane University’s School of Public Health
Health Systems in FCS: A “Snapshot” Limited availability of services Limited drug/medical supplies Weak/no funding of salaries and recurrent costs Few and inadequately trained health workers Poor/destroyed infrastructure Donor/NGO-dominated planning and service delivery Weak/no government policy and regulatory capacity
Service Delivery and FCS Poor countries in general suffer from service delivery and institutional weaknesses, including health services These weaknesses are indicators of state fragility when: A country’s service provision/coverage is significantly below average performance for countries with similar income levels Service provision/coverage is inequitably distributed and exclusionary
Absolute Service Delivery Failure ThresholdsService delivery indicator Average Standard State fragility thresholds (poor deviation countries) At risk FailedChild mortality rate 111.2 66.7 >177.9 >244.6(per 1000 live births)Primary school enrollment rate 72.1 21.1 <51.0 <29.9(% of cohort)Provision of improved water 69.8 17.2 <52.6 <35.4(% of population)
Fragility Rankings Country Authority Service Delivery Legitimacy Afghanistan Failing n/aDemocratic Republic Failing Failing At risk of the Congo Liberia At risk Failing
To Contribute to Reducing Fragility… HSS needs to Meet the health needs of affected populations Build capacity of health system to function effectively and sustainably Enhance state legitimacy Reinforce state authority
better systems, better health Thank you www.HealthSystems2020.orgAbt Associates Inc.In collaboration with:I Aga Khan Foundation I Bitrán y AsociadosI BRAC University I Broad Branch AssociatesI Deloitte Consulting, LLP I Forum One CommunicationsI RTI International I Training Resources GroupI Tulane University’s School of Public Health