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4 Challenges for Fragile States
Pages 43-50

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From page 43...
... • Mechanisms should be considered that can simultaneously advance local health priorities and public health humanitarian values while reducing infectious disease outbreak risk. (Kapila, Wise)
From page 44...
... • The need for persistent community engagement and mobiliza tion is demonstrated in issues such as population movement, weakening of democracy, and government corruption, which all lead to exclusion of health care users in the design of the system, and overall health system decline. (Heywood)
From page 45...
... Characterizing the West African Ebola crisis as a failure of trust, Kapila argued that "a proper paradigm for global health governance would be about the amount of trust there is between the governed and the governors." Global health governance unlinked to national and local health governance is not sustainable, he said. While Wise thought that governance is always related to the exercise of power, he acknowledged, WHO's power and how it is distributed and respected is a question of trust and deep legitimacy.
From page 46...
... These reforms must not only address issues of infectious disease surveillance and response, but must also address local public health needs, he added. It would be peculiar, if not perverse, to try to implement governance reforms in places with extremely high young child and maternal mortality, and have the reforms be confined to outbreak surveillance and response, he observed, because the former problem is ongoing and typically a priority for those communities suffering, and the latter is intermittent if not rare.
From page 47...
... Of South Africa's insufficient 74,000 community health care workers, 40,000 are being integrated into the country's health system, Heywood reported, and each earns a monthly wage of about $100. While this framework is not a strong basis for building effective health systems, it can play a role in disease identification, he pointed out.
From page 48...
... However, despite consumer belief to the contrary, private health care generally underperforms compared to public health care, particularly with regard to addressing HIV/AIDS. Ann Marie Kimball of Chatham House remarked that much of the discussion during this series of Global Health Risk Framework workshops had focused on the chronic health care deficits that set the context for the Ebola crisis.
From page 49...
... To do this, he added, would require giving users of health care systems far greater input, agency, and power than they currently possess -- and allowing them to maintain it beyond any individual crisis. Infectious disease outbreaks should be seen as parts of a continuum of vulnerability and risk, which requires a continuum of response and engagement to try to build responses, he urged.
From page 50...
... Duchin of Seattle–King County Public Health and the University of Washington pointed out the importance of developing a governance framework that addresses the potential for significant political upheaval, and Wise advised that awareness of political dynamics must somehow be integrated into health intervention programs from their inception. Duchin also expressed concern that many African colleagues -- key stakeholders in this process -- were not part of this workshop discussion, again highlighting the gap between the governed and those that govern.


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