Human resources for health are self-evidently critical to running a health service and system. In this paper, ReBUILD researchers Sophie Witter, Alvaro Alonso-Garbayo and Tim Martineau together with their co-authors, have explored a broader issue of the contribution which health staff might play in relation to the wider state-building processes.
Through a literature review covering many key disciplines and three case studies from Afghanistan, Burundi and Timor-Leste, they look for evidence to support, refute or adapt some possible linkages. Whilst they find that empirical evidence for most of the linkages is not strong (not surprising, given the complexity of the relationships), they argue that some of the posited relationships are plausible, including between development of health cadres and a strengthened public administration. They also find very different discourses in donor-generated literature compared to external academic studies, which tend to be more sceptical.
They conclude that whilst the concept of state-building itself is highly contested, it remains the case that state-building does occur over time, driven by a combination of internal and external forces and that understanding the role played in it by the health system and health staff, particularly after conflicts and in fragile settings, is an area worth further investigation.
Witter, S.; Falisse, J.B.; Bertone, M.P.; Alonso-Garbayo, A.; Martins, J.S.; Salehi, A.S.; Pavignani, E.; Martineau, T. State-building and human resources for health in fragile and conflict-affected states: exploring the linkages. Human Resources for Health (2015) 13 (1) 33. [DOI: 10.1186/s12960-015-0023-5]