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Disasters. 2011 Oct;35(4):639-60. doi: 10.1111/j.1467-7717.2010.01235.x.

Rebuilding and strengthening health systems and providing basic health services in fragile states.

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Basic Support for Institutionalizing Child Survival (BASICS) Project, Management Sciences for Health, Cambridge, MA 01239, USA.


The international community has compelling humanitarian, political, security and economic reasons to engage in rebuilding and strengthening health systems in fragile states. Improvements in health services and systems help to strengthen civil society and to restore legitimacy to governments. Effective engagement with fragile states to inform the design of health programmes and selection of interventions depends on donor coordination and an understanding of health system challenges. Planning requires consideration of allocation (services to be delivered), production (organisation of services), distribution (beneficiaries of services) and financing. The criteria for selecting interventions are: their impact on major health problems; effectiveness; the possibility of scale-up; equity; and sustainability. There are various options for financing and models of engagement, but support should always combine short-term relief with longer-term development. Stakeholders should aim not only to save lives and protect health but also to bolster nations' ability to deliver good-quality services in the long run.

[Indexed for MEDLINE]

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