Towards a Comprehensive Response to Health System Strengthening in Crisis-Affected Fragile States


Human security crises, and international responses to them, are a regular feature of the global landscape. Human security crises not only affect the population directly but also threaten the systems upon which the population depends, which include the health system. The weak health systems in fragile states are especially vulnerable to crises that can further weaken or even destroy them, resulting in these states being unable to implement critical health programmes - such as ones addressing infant and maternal mortality - or to respond to threats such as epidemics. This inability to meet the essential health needs of the population is further linked with increased mortality rates and retarded economic growth. The degradation of health systems may even undermine the population's confidence in the state itself, contributing to a cycle of increasing state fragility and deteriorating public services.

A joint team from the Harvard Medical School Department of Global Health and Social Medicine, Brigham and Women's Division of Global Health and Social Equity, the Harvard Humanitarian Initiative, as well as military and civilian members of NATO's Joint Analysis and Lessons Learned Centre (JALLC) have been involved in a study project since 2010 with the aim:

  • To infer elements of a strategic framework for health system strengthening in crisis-affected fragile states, focusing on the optimal use of contributions from global actors.

Project Overview
The purpose of this project as articulated by both NATO and Harvard was to examine how health system strengthening in crisis-affected fragile states is most affected, either directly or indirectly, by the activities of the security community, particularly through the employment of military capabilities. By doing so, it was anticipated that the Alliance could determine how to support the process of health system strengthening in the best manner within the scope of its crisis management core task.

The approach adopted to meet the aim and purpose of this project was based on case study research; this method was chosen given the need to understand a contemporary phenomenon in depth as well as within its historical and political context.

Main findings
The majority of the actors from the security, development and humanitarian communities agree that a safe and secure environment is a decisive condition for effective health system strengthening, which necessarily requires the engagement of the security community.

Coordination and mutual understanding among the key actors from the humanitarian, development and security communities are crucial to ensure coherent responses to health needs by all involved. Interaction is essential among the key health sector actors from both civilian and military communities.

The full article continues at on NATO’s website.