Fragile Environments

With some of the worst health indicators and the least adequate health services in the world, providing health services and rebuilding health systems in fragile states is a complex undertaking. This health and fragile states dossier highlights the challenges and approaches to delivering health services in fragile states. [from publisher]

This presentation was from the “Health Service Delivery in Fragile States for US$ 5 perperson per year: Myth or Reality?” conference. It discusses the limited public sector capacity to deliver priority services in fragile states and the opportunities and challenges of using non-state providers to increase coverage. [adapted from author]

This resource is a chapter from Disease Control Priorities in Developing Countries. Despite the best efforts of primary care providers and public health planners, not every emergency is preventable. Actual provision of emergency care may range from delivery using trained emergency professionals to delivery by laypeople and taxi drivers. Developing strategies to meet the range of needs posed by such diverse circumstances will require innovation and a reorientation of public health planning. [from introduction]

This article discusses the requirements for improving the experience of health care workers in fragile states. Efforts are needed to establish performance-management systems, to support promotion based on merit, and to provide wider opportunities for professional development. These efforts must be accompanied by measures to restructure the workforce (in some cases radically), thus matching staffing levels with agreed norms and to redress imbalances between rural and urban areas and between different levels within the system. [adapted from author]

The 2005 peace treaty between the government of Sudan and the Sudan People’s Liberation Army created a window of opportunity for rebuilding the south’s severely damaged health sector. The effort is getting an important boost from a program to bring back 15 Sudanese-born doctors who are ready to help. [adapted from author]

People caught in crisis situations have crucial reproductive health needs. The needs of pregnant women are most urgent. Complications of labor and delivery can be life-threatening when women lack adequate care. Risk for HIV/AIDS, other STIs, and unwanted pregnancy increases, particularly when disorder provides cover for rape and other sexual coercion. Health care providers understand people’s needs and have experience meeting them, but few have worked in humanitarian relief.