Fragile states are home to 15% of the world’s population. People
living there are more likely to suffer ill health and die
prematurely: half of all child deaths and a third of all maternal
deaths occur in fragile states. If the international community is
serious about addressing the Millennium Development Goals, there
has to be progress in those countries .
Managing the complexities of an effective health system is
particularly challenging in fragile states, where the capacity to
use increased donor funds effectively - the absorptive capacity -
tends to be constrained by many “in country” factors (political,
macroeconomic, infrastructure and capacity), as well as by certain
donor practices.
What can donors do?
When donor funds ran out, this Ugandan hospital
could no longer afford to maintain its ambulances
How can donors engage effectively with the health sector in fragile
states? What are the principles and approaches that will help to
address absorptive capacity constraints, and support long term
development of health systems? A paper by the HLSP Institute
highlights the key issues and offers ideas and suggestions for
donor engagement.
First, context is crucial. This should dictate the appropriate
instrument and the steps that need to be taken. And whatever
approach is developed, donors should avoid undermining those
systems already in place and must not overwhelm existing capacity
or divert it from more important functions. Second, donors’
priorities must be clear. The design of a programme should depend
on whether the donor aims to improve health outcomes, strengthen
the health system, or catalyse broader societal change.
Within all the components of the health system (stewardship,
financing, resource management and service delivery) there is a
range of interventions that donors can choose to support. As well
as choosing to support a specific function, donors can work on
these areas entirely with or outside government, or in an
“intermediate” way.
The paper
Absorptive capacity of health systems in fragile states
examines the range of approaches that are available to donors,
together with the specific issues associated with supporting each
of various components of the health systems.