Chapter 5

  • Sandy A. JohnsonEmail author


Failed states and states in conflict are special cases in terms of health and development in that the national government, the main party responsible for directing policy to improve national well-being, may lack the resources and/or the will to provide health infrastructure or opportunities for economic development. Although NGOs can fill the power and resource vacuum in these states in the short term, they may not contribute to sustainable health care delivery or development. A main policy challenge in failed and conflict-ridden states is how best to up-scale programs offered by diverse actors targeting health and/or development. The two case studies examined in this chapter are Partners-in-Health/Zamni LaSante in Haiti, which serves as a model for up-scaling, and the Government of Rwanda, which worked to consolidate and direct the resources of disparate non-governmental actors in order to meet national development and health goals.


Health Expenditure State Failure Economic Planning Humanitarian Assistance Conflict Area 
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  1. Anderson, M. (1996). Do no harm: Supporting local capacities for peace through aid. MA: Collaborative for Development.Google Scholar
  2. Bossert, T. J. (1984). Nicaragua health policy: The dilemma of success. Medical Anthropology Quarterly, 15(3), 73–74.Google Scholar
  3. Brainard, L., Chollet, D., & LaFleur, V. (2007). The tangled web: The poverty-insecurity nexus. In L. Brainard & D. Chollet (Eds). To poor for peace? Global poverty, conflict and security in the twenty-first century (pp. 1–30). Washington, DC: Brookings Institution Press.Google Scholar
  4. Brentlinger. P. (1996). Health sector response to the security threats during the civil war in El salvador. British Medical Journal, 313(7070), 1470–1474.Google Scholar
  5. Collier, P., Elliott, V. L., Hegre, H., Hoeffler, A., & Reynol-Querol, N. (2003). Breaking the conflict trap: Civil war and development policy. Washington, DC: World Bank and Oxford University Press.Google Scholar
  6. Connolly, M. A., Gayer, M., Ryan, M., Salama, P., Spiegel, P., & Heymann, D. (2004). Communicable diseases in complex emergencies: Impact and challenges. Lancet, 364, 1974–1983.CrossRefGoogle Scholar
  7. Council on Foreign Relations. (2009). Global economic trends: The business of aid. Transcript document. Accessed 22 June 2010.
  8. Curtis, D., & Oversees Development Institute (ODI). (2001). Politics and humanitarian aid: Debates, dilemmas, and dissension. Report of a conference organized by Oversees Development Institute, London, February 1, 2001. Accessed 22 June 2010.
  9. Davis, D., & Kuritsky, J. (2002). Violent conflict and its impact on health indicators in Sub-Saharan Africa, 1980–1997. Annual Meeting of the International Studies Association. New Orleans, LA.Google Scholar
  10. Donahue, J. M. (1984). Studying the transition to socialism in the Nicaraguan health system. Medical Anthropology Quarterly, 15(3), 70–71.Google Scholar
  11. Economist. (2000). NGOs: Sins of the secular missionaries. In R. Mansbach & E. Rhodes (Eds.). Global politics in a changing world (pp. 216–212). Boston: Houghton Mifflin Harcourt Publishing Company.Google Scholar
  12. Economist. (2010, January 7). Spoonful of ingenuity. The Economist. Google Scholar
  13. Esty, D. C., Goldstone, J. A., Gurr, T. R., Surko, P. T., Unger, A. N. (1995). Working papers: State failure task force report. Central intelligence agency. Accessed 23 Feb 2010.
  14. Farmer, P. (1992) Aids and accusation: Haiti and the geography of blame. Berkeley, CA: University of California Press.Google Scholar
  15. Farmer, P., & Garrett, L. (2007). From “marvelous momentum” to health care for all: Success is possible with the right programs. Foreign affairs. Accessed 6 Feb 2009.
  16. Foreign Policy & Fund for Peace. (2009). The failed states index 2009: FAQ & methodology—How the failed states index is made. Foreign policy. Accessed 23 Feb 2010.
  17. Fund for Peace. (2007). The fund for peace: Failed states index scores 2007. = 229&Itemid = 366. Accessed 23 Feb 2010.
  18. Garfield, R. (1984).Revolution and the Nicaraguan health system. Medical Anthropology Quarterly, 15(3), 69–70.Google Scholar
  19. Garrett, L. (2007). The challenge of global health. Foreign affairs. Accessed 12 Jan 2009.
  20. Gastineau Campos, N., & Farmer, P. (2003). Partners: Discernment and humanitarian efforts in settings of violence. Journal of Law Medicine and Ethics, 31, 506–515.CrossRefGoogle Scholar
  21. Ghobarah, H. A., Huth, P., & Russett, B. (2004). The post-war public health effect of civil conflict. Social Science and Medicine, 59, 869–884.CrossRefGoogle Scholar
  22. Goldstone, J., Bates, R., Epstein, D., Gurr, T. R., Lustik, M., Marshall, M., et al. (2010). A global model for forecasting political instability. American Journal of Political Science, 54(1), 190–208.CrossRefGoogle Scholar
  23. Gurr, T. R., & Harff, B. (1994). Ethnic conflict in world politics. Boulder, CO: Westview Press.Google Scholar
  24. Hansch, S., & Burkholder, B. (1996). When chaos reigns: Responding to complex emergencies. Harvard International Review, 18(4), 51–54.Google Scholar
  25. International Committee of the Red Cross (ICRC). (1996). Annex VI: Code of conduct for the international red cross and red crescent movements and NGOs in disaster relief. Accessed 13 Jan 2010.
  26. International Committee of the Red Cross (ICRC). (2010). The future of independent humanitarian action. Accessed 13 Jan 2010.
  27. Institute of Policy Studies (IPS). (2002). Sri Lanka national health expenditures 1990–1999. Colombo: Institute of Policy Studies.Google Scholar
  28. International Rescue Committee (IRC). (2007). Mortality in the democratic republic of the Congo: An ongoing crisis. International Rescue Committee New York. Accessed 26 Jan 2010.
  29. Johnson, S., & Samarasinghe, S. (2010). Violent conflict, health and well-being in Sri Lanka (Article in preparation).Google Scholar
  30. Kennedy, D., Holloway, D., Weinthal, E., Falcon, W., Erhlich, P., Naylor, R., et al. (1998). Environmental quality and regional conflict. A report to the carnegie commission on preventing deadly conflict. Accessed 3 Sept 2009.
  31. Kidder, T. (2009). Mountains beyond mountains: The quest of Dr. Paul farmer, a man who would cure the world. New York: Random House Trade Paperbacks.Google Scholar
  32. Lacey, M., & Thompson, G. (2010). Agreement on effort to help Haiti rebuild. The New York Times. Accessed 25 Jan 2010.
  33. Lee, J. W., Aylward, B., Hull, H., Batson, A., Birmingham, M., & Lloyd, J. (1997). Reaping the benefits: Getting vaccines to those who need them. In M. Levine, G. Woodrow, J. Kaper, & G. Cobon (Eds.), New generation vaccines (2nd ed.). New York: Marcel DekkerGoogle Scholar
  34. Logie, D., Rowson, M., & Ndagije, F. (2008). Innovations in Rwanda’s health system: Looking to the future. Lancet, 372, 256–261.CrossRefGoogle Scholar
  35. Macrae, J. (1994). Dilemmas of legitimacy, sustainability, and coherence: rehabilitating the health sector. In K. Kumar (Ed.), Rebuilding societies after civil war: Critical roles for international assistance. Boulder, CO: Lynne Rienner Publishers.Google Scholar
  36. Matul, M., & Tsilikounas, C. (2004). Role of microfinance in the household reconstruction process in Bosnia and Herzegovina. Journal of International Development, 16, 429–466.CrossRefGoogle Scholar
  37. Messer, E. (1993). Food wars: Hunger as a weapon of war in 1993. In P. Uvin (Ed.), The hunger report 1993 (pp. 43–70). Langhorne, PA: Routledge.Google Scholar
  38. Ministry of Finance and Economic Planning, Republic of Rwanda. (2000). Rwanda Vision 2020. Kigali, July 2000. Accessed 22 June 2010.
  39. Ministry of Finance and Economic Planning, Ministry of Health, Republic of Rwanda. (2006). Scaling up to achieve the health MDGs in Rwanda: A background study for the high-level forum meeting. Tunis: Republic of Rwanda.Google Scholar
  40. Mukherjee, J., Colas, M., Farmer, P., Leandre, F., Lambert, W., Raymonville, M., et al. (2003). Access to antiretroviral treatment and care: The experience of the HIV equity initiative. Cange, Haiti: World Health Organization.Google Scholar
  41. Münkler, H. (2009). The new wars. In R. W. Mansbach & E. Rhodes (Eds.), Global politics in a changing world (pp. 38–48). Boston: Houghton Mifflin Harcourt Publishing Company.Google Scholar
  42. Murshed, S. M. (2002). Conflict, civil war and underdevelopment: An introduction. Journal of Peace Research, 39(4), 387–393.CrossRefGoogle Scholar
  43. New York Times. (2010). Haiti. = 1-spot&sq=Haiti%20earthquake&st=cse. Accessed 1 May 2010.Google Scholar
  44. Rubardt, M. (1985). A glimpse of health care in turbulent Nicaragua. American Journal of Nursing, 85(7), 783–784.CrossRefGoogle Scholar
  45. Soeters, R., Habineza, C., & Peerenboom, P. B. (2006). Performance-based financing and changing the district health system: Experience from Rwanda. Bulletin World Health Organization, 84(11), 884–889.Google Scholar
  46. Toole, M. J., & Waldman, R. (1993). Refugees and displaced persons: War, hunger, and public health. JAMA, 250(5), 600–611.CrossRefGoogle Scholar
  47. United Nations High Commissioner for Refugees (UNHCR). (2009). 2008 Global trends: Refugees, asylum-seekers, returnees, internally displaced and stateless persons. United Nations. 6.html. Accessed 22 June 2010.
  48. Van Hear, N., & Harrell-Bond, B. (1991). Refugees and displaced people: Health issues. In united nations institute for training and research. The Challenge of African Disasters (pp. 7660–76). New York: United Nations.Google Scholar
  49. Walton, D. A., Farmer, P. E., Lambert, W., Leandre, F., Koenig, S., & Mukherjee, J. S. (2004). Integrated HIV prevention and care strengthens primary health care: Lessons from rural Haiti. Journal of Public Health Policy, 25(2), 137–158.CrossRefGoogle Scholar
  50. Williams, H. (1984).An uncertain prognosis: Some factors that may limit future progress in Nicaraguan health care system. Medical Anthropolgy Quartely, 15(3), 72–73.CrossRefGoogle Scholar
  51. World Bank. (2009) World development indicators. = 12&id = 4&CNO = 2. Accessed 5 March 2010.
  52. World Health Organization (WHO). (2009a). 2009 State of the world’s vaccines and immunizations (3rd ed.). Accessed 6 June 2010.
  53. World Health Organization (WHO). (2009b) Global health observatory. 2 March 2010.
  54. World Health Organization (WHO). (2010). Haiti: Health profile. Accessed 2 Nov 2010.
  55. Zartman, I. W. (1995). Introduction: Posing the problem of state collapse. In Zartman (Ed.), Collapsed states: The disintegration and restoration of legitimate authority. Boulder: Lynne Rienner.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Josef Korbel School of International StudiesUniversity of DenverDenverUSA

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