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Making sense of apparent chaos: health-care provision in six country case studies

Published online by Cambridge University Press:  30 January 2014

Enrico Pavignani ,
Markus Michael ,
Maurizio Murru ,
Mark E. Beesley  and
Peter S. Hill
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Abstract

This research examines the impact on health-care provision of advanced state failure and of the violence frequently associated with it, drawing from six country case studies. In all contexts, the coverage and scope of health services change when the state fails. Human resources expand due to unplanned increased production. Injury, threat, death, displacement, migration, insufficient salaries, and degraded skills all impact on performance. Dwindling public domestic funding for health causes increasing household out-of-pocket expenditure. The supply, quality control, distribution, and utilisation of medicines are severely affected. Health information becomes incomplete and unreliable. Leadership and planning are compromised as international agencies pursue their own agendas, frequently disconnected from local dynamics. Yet beyond the state these arenas are crowded with autonomous health actors, who respond to state withdrawal and structural violence in assorted ways, from the harmful to the beneficial. Integrating these existing resources into a cohesive health system calls for a deeper understanding of this pluralism, initiative, adaptation and innovation, and a long-term reorientation of development assistance in order to engage them effectively.

Keywords

health sectorstate failureconflicthealth-care provisionstatelessnessprivatisationcommoditisationstructural violence
Type
Research Article
Information
International Review of the Red Cross , Volume 95 , Issue 889: Violence against health care Part I: The problem and the law , March 2013 , pp. 41 - 60
Copyright
Copyright © icrc 2014 

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