Health system reconstruction: can it contribute to state-building?

Jack Eldon, Catriona Waddington and Yasmin Hadi for the Health and Fragile States Network, October 2008

There have been increasing attempts to link development aid with the need for improved stability and security at the national, regional and international levels. Building resilient and responsive states in fragile environments is central to this agenda.

This paper examines whether rebuilding health systems strengthens the social contract between state and society and contributes to state-building.

• The hypothesis is that building health systems helps to strengthen state capacity and signals increased willingness of the state to act on behalf of citizens in a responsive and accountable manner. This generates enhanced support for the state (legitimacy) and a stronger social compact between state and society. The planning, management and delivery of health services also contributes to capacity beyond the sector.
• The paper finds that health sector strengthening can contribute to state building in the sector. It can help build legitimacy and capacity, and put health on the statebuilding agenda.
• The impact of health sector interventions on wider state-building is unclear and requires further study.

The paper was commissioned by the Health and Fragile States Network