Fragile states refer to those states with an unstable political system. This means that these countries have a history of civil strife or war with neighboring autonomous political entities. Political instability has serious implications on the state of government and the provision of social amenities in the areas that are affected (Levy 2008, p.51). The greatest effect of political instability is that the countries have poor economies. The fragile states have a myriad of problems arising from poor coordination of their activities (Brock 2011, p.78).
The United Nations has initiated programs to develop these countries’ social amenities up to an international level. These goals are scheduled to be achieved by 2015 and are known as Millennium Development Goals. These targets require an appropriate environment for them to be achieved (Sharp 2011, p.73).
This means that any country with an unstable economy is likely to have trouble in achieving these goals (Brinkerhoff 2007, p.62). Furthermore, these millennium development goals require foreign funding to a considerable extent. The willingness of the donor countries to cooperate with the United Nations in the funding of the projects determines the fate of the MDGs.
Millennium Development Goals have many objectives within their scope. Quality health for all the citizens of the fragile states is one of the major aims of the programs by the United Nations. Since the majority of the population in these countries consists of poor people, the United Nations has to work closely with the governments of these countries to achieve its objectives (Manor 2007, p.37).
Some governments in the fragile states, which are uncooperative, and too preoccupied with political issues to attend the development issues, compound the difficulties experienced by the United Nations. Illiteracy in these countries is still high, and this makes it difficult to get the citizenry to cooperate over the issue of development. Since health requires a considerable degree of funding and a high level of awareness, quality is low in these countries.
Background
The concept of fragile states revolves around political and economic stability. Any country with the tendency to experience a sharply changing political or economic status is considered a fragile state. Political stability and economic prosperity are directly related to each other. This means that a poor economy is likely to have an unpredictable political atmosphere. Likewise, an unstable political atmosphere results in a continuously changing rate of economic progress.
These countries are not necessarily poor, but they have a continuously deteriorating economic status. Some countries have had such a situation for a long time. Health has been one of the greatest losers due to political and economic instability. The basic criterion of determining fragile states is the level of efficiency and the legitimacy of the authority in charge. Effectiveness refers to the efficiency of the authority, and the willingness of the government in a state to respond to a problem. On the other hand, legitimacy refers to the ability of the government to assert authority in the major aspects of governance. The aspects of governance include the provision of health care services.
Fragile states have the worst conditions in almost every sector compared to other countries in the world. Consequently, these states have a greater proportion of poor people than any other country. It is estimated that the fragile states have a third of the world’s poor population. These countries also have a third of the world’s unhealthy population.
Although the majority of the fragile states are developing countries, not all developing countries are fragile states. Long periods of instability in these countries have led to the deterioration of health facilities, and neglect of the necessary funding required in achieving equitable health status around the world. In general, the state must be able to provide a legitimate and rigid framework for the establishment of an effective health system.
Introduction
In a fragile state, the government is not in a position to provide a basic framework for the provision of quality health care. This has often resulted in a humanitarian crisis with a high rate of spread of diseases and rising mortality rates. The unhealthy population that results from such a state is not as productive as it is expected of a population with a reasonably stable healthcare system (Walker & Maxwell 2009, p.45). In particular, fragile states do not have a rigidly set framework for developing health policies.
Implementation of policies in the government agencies is also slow, and sometimes it is not implemented at all. Even the averagely endowed countries such as Pakistan remain with an ailing health system due to the relative instability of the country (Manning 2009, p.65).
Several international development agencies have taken the initiative to establish an aid system to help these countries establish an effective health care system. The common goal is to provide functional and effective health care within the community. This effort by the international agencies to strive to meet the requirements of the MDGs has several factors affecting it (Link 2007, p.57).
The first problem in the fragile states is the control of the health facilities and the healthcare system for proper development of the countries’ healthcare system. For the development agencies and the state to establish a functional healthcare system, there must be a grip on the resources necessary to set up an efficient health system.
The government should have control of the health sector for the millennium development goals to be achieved. Fragile states lack this permanent control of the health sector and resources. This makes the goal of achieving health for all people in the world by 2015 an unrealistic feat.
Analysis
For an effective health system to be realized, the government has to be transparent and accountable. This will help the country to attract donors for the health sector. It is important for the government to facilitate accountability for the available resources, and any fund intended for development in the health sector (Higginbotham & León 2001, p.45). Lack of transparency and accountability in the health sector is the major cause for the stagnation of the health sector in fragile states.
The health system lacks transparency often due to policies and the control that the government exerts on the usage of any funds intended for health care. The realization of MDGs pertaining to health care in these countries requires an administration that keeps an elaborate track of the spending of donor funds and the observation of policies in the developing countries (Carment 2001, p.152).
A fragile state may not be able to provide a constant and stable funding for the health sector. Other sources of income for the sector are then necessary. The government has to instil confidence in the donors and the people who are responsible for the health services provision at the grassroots level. The most important factor that facilitates this is the ability of the state to provide protection for the health services institutions and the public. The security provided for the health services institutions refers to the financial security of the healthcare system (Skolnik 2008, p.56).
In many countries that are considered fragile, physical violence is rampart, and the public is prone to this violence. The level of violence varies among the various states that are considered fragile. In this kind of an environment, the health institutions find it difficult to operate. In a country where the security systems have collapsed, it is difficult for the public to access quality health care due to the insecurity that health workers face.
This influences the specialised health services that can only be provided by specialised personnel. Fragile states may not be able to provide basic health facilities such as conventional basic health care. All these problems are caused by the instability of the country in terms of resources or political leadership. Failure of political leadership has more implications on the health sector of the country. Medical personnel may refuse to work in the country if the condition in the country is extremely dangerous.
This is particularly common in the failed states, where the rule of law is absent. The extensive destruction of the healthcare system by the violence often sets back the development of the health sector in such countries. A combination of factors contributes to this. The anarchy and disorder that prevails in such a state prevents the government from performing duties such as provision of basic health care.
On the other hand, economic instability in the countries results in a situation where the health provision agencies cannot set a standard for financing the provision of health care. Sometimes, the responsible financiers of the health system may fund it adequately. However, due to the frequent and unpredictable economic situation, the government and the health agencies are unable to provide quality health care to the public.
It is difficult to structure a program to help fragile states prosper in any sector. In such states, government policies change too frequently for the health agencies to establish a secure programme to improve healthcare in the country. The health care system is disrupted by the fluctuating financial situation in the country. The donors for the health sector are discouraged by the nature of financial and security systems in the health sector (Washer 2010, p.59).
Programmes established to promote health in fragile state are also prone to the effects of the fragile economy and healthcare structure. Preventive measures cannot be implemented to avert the occurrence of serious and widespread health conditions in the country. In the warring countries, humanitarian crises may claim lives for years and go unattended since the state of security is too poor for any willing volunteer or government to offer any health services to the public.
Fragile States and the International Community
Fragile states are a concern to the international community. These states cause a political risk to the rest of the world. The anarchy and instability that prevails in these countries may spread to other countries when problems such as terrorism, infectious diseases, and insurgency prevail in these countries. It is important for the international community to implement plans to stabilise the economic and the political structure of such countries.
To achieve full stability of these countries, it is necessary to provide goals for health care improvement. Recently, the United Nations initiated a program to counter the current state of poor health in most parts of the world by ensuring that people lead healthy lives. These goals are necessary to realise full productivity of the world population. In addition, health is necessary to promote the campaign to eradicate poverty in the world (Annan 2005, p.12).
The United Nations, which is in a position to oversee such a project for all countries in the world, is leading in the initiative to establish functional and efficient health care systems around the world by 2015. This is a millennium development goal for the world powers to achieve before the set time. This feat is supposed to be achieved by cooperation between the countries with poorly performing health sector and those with relatively plenty of resources (WHO 2011,p.45). Other health provision agencies other than the state machinery are also involved in the quest for a better health care by the set date.
While some countries with inefficient health systems are taking up the challenge and addressing the health issues, other states are not cooperative, or are not in a position to respond to the distress in the health sector. A third of the states around the world are fragile by definition (Rechel et al 2004, p.75).
These countries are also mostly populous countries, which are prone to humanitarian crisis and disease outbreaks. If these countries do not establish a good healthcare system soon, they might brew disaster for the whole of the world. Recent outbreak of lethal diseases is an example of the possible crises that could occur if the condition in these countries continues unabated (Picazo 2009, p.251). Examples of diseases that have plagued the world due to lack of mechanisms to control them is the bird flu and the viral disease Ebola. Ebola is a lethal disease from the swamps of Congo.
When the disease first broke out, it was detected in a population living in a swampy area in Congo (Garrett 1994, p.155). The country was in a state of war, and could not control the spread of the disease. The only factor that deterred the disease from becoming a lethal epidemic on a global scale is the speed with which it killed its victims. There was not enough time between infection and death of the victims to allow the disease to spread in a large population.
This is an example of a lethal disease that could plague the world due to the poor health provision systems in the use. Another example of a disease that could have brought a disaster to the world is the avian flu that affected humans. The disease began spreading from the Far East in an area with a poor population in a fragile economy (Wagstaff & Claeson 2004, p.37). The epidemic went on for several months unabated by the country of origin due to the poor alertness of the healthcare system.
The disease was stopped by its obvious symptoms that facilitated isolation of the affected individuals. This shows the effect that an infectious disease with mild symptoms could have on the world population in case such an epidemic emerged in the near future (Sama & Nguyen 2008, p.25). The current global healthcare system is too weak to defend against such an occurrence. This clearly brings out the importance of the Millennium Development Goals.
The current situation in the world does not support the United Nations aim of realising the MDGs. This is because the concerned countries are not cooperative in the endeavour (UNO 2003, p.12). For political reasons, the countries with the capability of giving aid to the poor countries are not willing to give the aid to the affected areas. This has led to lack of enough financial resources to deal with the health situation around the world (Liebowitz et al 2010, p.48).
Studies show that although developed countries continue to give aid, the funds are not directed at the most affected areas of the economy. Most of the funds are directed to agencies that misappropriate them. This trend has continued for decades since it is powered by the world politics (WHO 2005, p.62). The powerful countries are interested in spreading their influence in the world economy rather that funding plans to establish a system for global health.
On the other hand, the fragile states, which are mostly the developing economies, are keen to protect their sovereignty (Ottaway & Carothers 2000, p.95). Thus, they avoid funds with string attached from the developed nations. In some of the countries affected by the health problems, the government is not legitimate, and is interested at asserting its authority rather than ensuring global health by playing their parts in the international effort to achieve MDGs pertaining health.
In Africa, governments that are keen to maintain their authority have ignored the guidelines that govern the states that aim to attain the MDGs (United Nations 2003, p.64). In this continent, very few governments are on track towards achieving the said goals. The most probable result is that the countries in this continent are unlikely to achieve these MDGs by the set dates (Jensen 2010, p.82).
The current trend around the world shows that the direction that the world powers have taken in the quest to achieve health for all people according to the millennium development goals guidelines is not realistic. It is necessary to separate the political issues in the world from the health care system (Addison & Odedokun 2003, p.25).
A close analysis of the events around the world indicates that the world politics and the health issues cannot be handled on the same platform. While the world politics affect the individual countries in which they are active, health affects the whole world (Burnell 1997, p.125). This means that a health problem in one part of the worlds is likely to pose danger to the other parts of the world, irrespective of the economic status of the countries.
The solution can be found if the world economies succeed in separating their political issues from the policies that are meant to guide the efforts to realisation of the Millennium Development Goals (Rashid 2008, p.154). Experts estimate that the world has enough resources to deal with the disparities that it surfers in provision of social amenities and health care (Boyd 2008, p.52). The policies that govern the distribution of wealth around the world determine the course of the efforts to establish uniform health among the world’s countries and societies.
The world’s donors should focus more on the root causes of poverty in the quest to establish a uniform world economy. Funding development projects directly may not be the best solution for the word’s poor population. However, focussing on provision of social amenities such as health, and provision of quality education could be more productive (UN 2008, p.24).
Enhancement of these base factors is likely to result in a healthier population, which is more capable of production. Since the current approach to eradication of poverty and disease has failed to meet the expected results, the concerned authorities and organisations should adopt a different approach to the issue.
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