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

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Presentation on theme: "Health governance in fragile states Lessons from early recovery fragile states…. Laurie Zivetz, MPH, PhD."— Presentation transcript:

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

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

3 Assumptions: 1.Effectiveness + legitimacy = governance 2.Development assistance can have greater impact on effectiveness 3.Stewardship begins with a regulatory role

4 ClientsProviders Humanitarian Agencies State 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? 1.Accountability and capacity concerns 2.Political considerations

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

9 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

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 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

12 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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