By Egbert Sondorp, HSG Board Candidate 2016
With yet another round of violence over the past few weeks, these are sad days for South Sudan. Again many deaths, and tens of thousands people on the move. A political settlement, so much needed to resume the process of state and even nation building, seems further away than ever.
Over the past four years I have spent much time and energy to make a small contribution to strengthen South Sudan’s health system, in particular around maternal health. The maternal mortality rate is one of the highest in the world, and core to South Sudan’s health policy. Some days of despair always seem to be followed by glimpses of hope and progress, working with motivated individuals at national and subnational levels, and engaging with – highly resilient – South Sudanese people and communities.
We and others try to set up programmes adapted to the circumstances using the very limited evidence on how to operate in these type of environments. It is about 10 years now that the international community started to use the term ‘fragile states’, for want of a better term. Not so easy to define, but aiming to indicate a group of around 40 countries, home to over a billion people, who seriously lag behind on a range of health indicators, like child and maternal mortality. Initially defined as ‘countries who lack the will or capacity to implement pro-poor policies including delivery of services’, these days there is more recognition of the variation between countries and different elements of fragility. Fragile states are diverse, but have weak institutions in common. And this key notion of ‘weak institutions’ is obviously also a pervasive element with everything that relates to a fragile country’s health system. We know that we do need to “do things differently” and focus on “different things” as was formulated at the time of signing the New Deal for Engagement in Fragile States in 2011.
How does this relate to health policy and systems research and the role of HSG? In the Thematic Working Group on Health Systems in Fragile and Conflict Affected States we have managed to make a beginning with a broad membership and some engaging activities, including recently published work on identifying health systems research needs in fragile states. However, there is still the major issue of how to engage better with health system practitioners and researchers from fragile states. ‘National chapter’ or similar local entities for engagement hardly exist in these countries. We need to engage with individuals, but it seems we still lack effective technology as well as the human (and partly financial) resources to pro-actively engage.
I hope that HSG at large will more explicitly recognise, also in its new strategic plan, the specific needs for HPSR and the needs of researchers and practitioners in fragile states. During the recent online consultation for the strategic plan, HSG members discussed the themes of ‘home and voice’, ‘advocacy’ and ‘growing our membership in less-represented geographies and stakeholder communities’, which are all highly pertinent to fragile states. It will take special effort to also include people from these countries in our wider community. Jointly we need to learn how to “do things differently”.