Challenging the discourse on fragile states

Ikpe, Ekaette

doi:10.1080/14678800601176543

Cited by 21 publications

(11 citation statements)

References 5 publications

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“…What is clear however, is that health care beyond the limited reach of state services, has developed into a privatised, commoditised and largely unregulated service. Within this context, as in other fragile states, the scope of public services, including health care provided by the state is extremely limited, yet research has continued to largely focus on this formal public health sector which provides the minority of health care [ 19 – 21 , 31 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is the result of a range of exogenous and endogenous pressures including history, violent conflict, political instability, multiple disasters and human agency. These factors render the state in a perpetuating cycle of fragility and an enduring state of emergency resistant to remedy, vulnerable to recurrent shocks and stuck in underdevelopment [ 8 , 33 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

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Haïti and the health marketplace: the role of the private, informal market in filling the gaps left by the state

Durham

Michael

Hill

et al. 2015

BMC Health Serv Res

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BackgroundIn most societies the health marketplace is pluralistic in character, with a mix of formal and informal providers. In high-income countries, state regulation of the market helps ensure quality and access and mitigate market failures. In the present study, using Haiti as a case study, we explore what happens to the functioning of the pluralistic health marketplace in severely disrupted environments where the informal sector is able to flourish.MethodsThe overall research design was qualitative. Research methods included an extensive documentary and policy analysis, based on peer-reviewed articles, books and “grey” literature--government policy and program reports, unpublished research and evaluations, reviews and reviews from key multilateral and bilateral donors, and non-government organisations, combined with field site visits and in-depth key informant interviews (N = 45).ResultsThe findings show that state fragility has resulted in a privatised, commoditised and largely unregulated and informal health market. While different market segments can be identified, in reality the boundaries between international/domestic, public/private, for profit/not-for-profit, legal/illegal are hazy and shifting.DiscussionThe lack of state capacity to provide an enabling environment, establish, and enforce its regulatory framework has resulted in a highly segmented, heterogeneous and informal health market. The result is deplorable health indices which are far below regional averages and many other low-income countries.ConclusionsWorking in fragile states with limited capacity to undertake the core function of securing the health of its population requires new and innovative ways of working. This needs longer time-frames, combining incremental top-down and bottom-up strategies which recognize and work with state and civil society, public and private actors, formal and informal institutions, and progressively facilitate changes in the different market functions of supply, demand, regulation and supporting functions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Haïti and the health marketplace: the role of the private, informal market in filling the gaps left by the state

Durham

Michael

Hill

et al. 2015

BMC Health Serv Res

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“…The LICUS classification reflects level of income, and an assessment of national policies, institutions and public sector management. It was selected on the basis of its comprehensiveness, wide acceptance and the direct correspondence of its time frame (2006) to the application process (Ikpe 2007). Eighteen applications were received from LICUS states.…”

Section: Methodsmentioning

confidence: 99%

Linking programmes and systems: lessons from the GAVI Health Systems Strengthening window

Galichet

Goeman²,

Hill

et al. 2010

Tropical Med Int Health

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Summaryobjectives To analyse the first four rounds of country applications to the GAVI Alliance Health Systems Strengthening (GAVI-HSS) funding window; to provide valuable insight into how countries prioritize, articulate and propose solutions for health system constraints through the GAVI-HSS application process and to examine the extent to which this process embodies alignment and harmonization, Principles of the Paris Declaration.methods The study applied multiple criteria to analyse 48 funding applications from 40 countries, submitted in the first four rounds, focusing on the country analysis of health systems constraints, coordination mechanisms, alignment with national and sector planning processes, inclusiveness of the planning processes and stakeholder engagement.results The applications showed diversity in the health systems constraints identified and the activities proposed. Requirements of GAVI for sector oversight and coordination, and the management of the application process through the Ministry of Health's Planning Department, resulted in strong alignment with government policy and planning processes and good levels of stakeholder inclusion and local technical support (TS).conclusion Health Systems Strengthening initiatives for global health partnerships (GHPs) can provide a link between the programmatic and the systemic, influencing policy alignment and harmonization of processes. The applications strengthened in-country coordination and planning, with countries using existing health sector assessments to identify system constraints, and to propose. Analyses also produced evidence of broad stakeholder inclusiveness, a good degree of proposal alignment with national health plans and policy documents, and engagement of a largely domestic TS network. While the effectiveness of the proposed interventions cannot be determined from this data, the findings provide support for the GAVI-HSS initiative as implementation continues and evaluation begins.

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“…It reinforces notions of fragility as being on a spectrum where some states appear to be on the brink of collapse with others exhibiting a level of resilience and yet facing immense vulnerability. 61 This latter designation has come to define the Nigerian context since the escalation of the Niger Delta conflict from the mid-2000s to the current crisis in the North since 2009. The actions of Boko Haram are especially pertinent in the post 9/11 global security discourse where violent extremism underscored by fundamentalism along religious lines has fed into an anti-terror frenzy.…”

Section: The Case Of Nigeriamentioning

confidence: 99%

Counting the development costs of the conflict in North-Eastern Nigeria: the economic impact of the Boko Haram-led insurgency

Ikpe

2017

Conflict, Security & Development

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Challenging the discourse on fragile states

Cited by 21 publications

References 5 publications

Haïti and the health marketplace: the role of the private, informal market in filling the gaps left by the state

Haïti and the health marketplace: the role of the private, informal market in filling the gaps left by the state

Linking programmes and systems: lessons from the GAVI Health Systems Strengthening window

Counting the development costs of the conflict in North-Eastern Nigeria: the economic impact of the Boko Haram-led insurgency

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