Implications of security rationales for health aid in fragile states

Purpose: Initiatives to strengthen health systems in fragile states are increasingly viewed as means for advancing security, promoting state stability, and winning “hearts and minds.” Three questions relating to the use of this foundation for policies on strengthening health systems in fragile states arise. First, what do we know about whether, assuming interventions are tailored to meeting these goals, health interventions are likely to achieve the goals of stability or security. Second, what are the implications for how interventions are designed and implemented, e.g., the role of “quick impact” projects, the role of the military. Third, to what extent are health programs designed to improve stability and security likely to achieve health systems development objectives set out in international principles of aid effectiveness in health. Data and Methods: Information to answer these questions will be drawn from US policy documents; descriptions and evaluation of health programs in from places of active conflict, including Afghanistan, and regions where interventions are used as a preventive measure, such as the Horn of Africa, by civilian and military agencies; and principles of health systems development. Results: The use of security and stabilization justifications for health programs in fragile states a) tend to favor short-term programs that are unlikely to be sustainable; b) depart from accepted principles of health system development; and c) do not contribute substantially to security and short-term stabilization objectives. Policy implications: Health policy in fragile states based on security and stabilization ideas is not an effective aid strategy.