1. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health 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, 2012

2. 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

3. 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

4. Absolute Service Delivery Failure Thresholds Service delivery indicatorAverage (poor countries) Standard deviation State fragility thresholds At riskFailed Child mortality rate (per 1000 live births) 111.266.7>177.9>244.6 Primary school enrollment rate (% of cohort) 72.121.1<51.0<29.9 Provision of improved water (% of population) 69.817.2<52.6<35.4

5. Fragility Rankings CountryAuthorityService DeliveryLegitimacy AfghanistanFailingn/a Democratic Republic of the Congo Failing At risk LiberiaAt riskFailing

6. Health Interventions in FCS

7. 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

8. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health better systems, better health Thank you www.HealthSystems2020.org