Health system strengthening in fragile and conflict-affected states: a call to action

Although the speed of global development has been impressive, not all countries have developed at the same pace. The World Bank Group (WBG) report that Fragile and Conflict-Affected States (FCAS) are those countries that have lower health and development outcomes, and risk not being able to achieve Sustainable Development Goals (SDGs) in the next few years. Health systems play an important role in building capacity and infrastructure that can lead towards fulfilling the SDGs. In this editorial, we set the context, and launch a call to action, for a BMC Health Service Research Collection titled “Health services and systems in fragile and conflict-affected regions”.

Deals and development in fragile and conflict-affected states: Framework and policy guidebook

This framework utilizes business interests and the distribution of political power to understand the episodic nature of economic growth in fragile and conflict-affected states. Conflict, state capacity, and legitimacy are analysed alongside the business environment and structural transformation to explain when growth episodes arise and when those growth episodes have positive, or negative, feedback on the country’s political economy and state fragility. The guidebook is designed to help advisers working with development agencies to analyse country context and design interventions with the goal of enabling positive growth episodes that reduce fragility.

“New” State Actors and Conflict-Affected States: Confronting Violence, Shifting Ambitions, and Adjusting Principles

Over the past couple of decades, “new” state actors, such as Brazil, China, Russia, India, Turkey, and countries of the Arab Gulf, have been playing an increasingly prominent role in assistance provision to conflict-affected states. Skeptical of the liberal peace-building model, they have emphasized supporting economic development and avoided promoting political reforms, viewing them as too interventionist in domestic affairs of conflict-affected states. Rather, they have emphasized solidarity, cooperation, mutual support, and respect for state sovereignty; and they are committed to non-intervention norms. However, the foreign policies of “new” state actors have been far from static. This article argues that these norms mask more complex relationships between “new” state actors and conflict-affected states. Historically, the “new” actors have tended to adhere less to non-intervention norms in their immediate neighborhood. Now, as they become more deeply engaged with countries emerging out of violent conflict, have come to aspire playing more prominent global roles, and the competition among them has risen, their adherence to principles of non-interference is under strain and policies regarding issues of peace and security are shifting.

Tailoring IMF-Supported Programs to Fragile and Conflict-Affected States’ Needs

We consider the impact of Fund-supported programs in fragile and conflict-affected states (FCS) on aid flows and what factors determine program success. Using several indicators of fragility in a multivariate setting, we find that the catalytic role of IMF engagement on aid is significant in general and particularly so in fragile states. There is clear evidence that risks are more elevated in FCS due to conflict and political instability. Probit analysis for metrics of program success indicates that programs in FCS have a significantly higher probability of non-completion than non-FCS. We find a strong negative effect of high public debt on program completion. Usage of prior actions is associated with weaker program performance, suggesting that their use occurs in situations that are perceived as more risky. We recommend a greater focus on the drivers of conflict and instability in FCS and consideration of program measures that contribute to better economic outcomes.

Reformation of Public Administration in Conflict-Affected States

This chapter investigates the reformation process of public administration in the Republic of Sudan after the Comprehensive Peace Agreement signed in 2005. Adopting decentralization as the key solution to conflict, reformation of public administration in Sudan found its impetus after the CPA. International organizations, namely the World Bank, United Nations Development Programme, Organization for Economic Co-operation and Development, and the International Monetary Fund, have engaged with Sudan through a variety of structural and sectoral adjustment programs. Drawing heavily on the analysis of related policy documents, this chapter, ultimately, seeks to depict how public administration reforms are identified and structured in conflict-affected contexts, compared to safe and stable conditions. At this point, it can be concluded that Sudan needs to determine its constitutional political identity first for succesful transition to democracy. Sudan seems unlikely to complete reforming its public administration unless it could have resolved issues of democratic transition and poverty.