JALLC - Health

Skip menu in to the page contents area

North Atlantic Treaty OrganizationNATO

Joint Analysis & Lessons Learned CentreJALLC

NATO 's Lead Agent for Lessons Learned

Towards a Comprehensive Response to Health System Strengthening in Crisis-Affected Fragile States

Harvard Crest
Harvard Medical School
Department of Global Health
and Social Medicine
NATO Joint Analysis &
Lessons Learned Centre


Human security crises, and international responses to them, are a regular feature of the global landscape. Human security crises not only affect the population directly but also threaten the systems upon which the population depends, which include the health system. The weak health systems in fragile states are especially vulnerable to crises that can further weaken or even destroy them, resulting in these states being unable to implement critical health programmes - such as ones addressing infant and maternal mortality - or to respond to threats such as epidemics. This inability to meet the essential health needs of the population is further linked with increased mortality rates and retarded economic growth. The degradation of health systems may even undermine the population's confidence in the state itself, contributing to a cycle of increasing state fragility and deteriorating public services.

A joint team from the Harvard Medical School Department of Global Health and Social Medicine, Brigham and Women's Division of Global Health and Social Equity, the Harvard Humanitarian Initiative, as well as military and civilian members of NATO's Joint Analysis and Lessons Learned Centre ( JALLC) have been involved in a study project since 2010 with the aim:

Project Overview
Open the Helthcare Project Overview

(12 June 2012)
To infer elements of a strategic framework for health system strengthening in crisis-affected fragile states, focusing on the optimal use of contributions from global actors.

The purpose of this project as articulated by both NATO and Harvard was to examine how health system strengthening in crisis-affected fragile states is most affected, either directly or indirectly, by the activities of the security community, particularly through the employment of military capabilities. By doing so, it was anticipated that the Alliance could determine how to support the process of health system strengthening in the best manner within the scope of its crisis management core task.

The approach adopted to meet the aim and purpose of this project was based on case study research; this method was chosen given the need to understand a contemporary phenomenon in depth as well as within its historical and political context.

Main findings.

The majority of the actors from the security, development and humanitarian communities agree that a safe and secure environment is a decisive condition for effective health system strengthening, which necessarily requires the engagement of the security community.

Project Closure
Open the Helthcare Project Closure

(29 January 2014)

Coordination and mutual understanding among the key actors from the humanitarian, development and security communities are crucial to ensure coherent responses to health needs by all involved. Interaction is essential among the key health sector actors from both civilian and military communities.

Lack of governance causes not only inefficient management in the health sector, but also may provide the opportunity for corruption, which demands a continuing commitment from security community actors to combat.

No proof was found that the success of direct medical engagements led by security actors contributes to a wider strategy to win hearts and minds. Direct health interventions by military actors have been recognized to be counter-productive because they undermined the confidence of the people in the capabilities of local and national government - i.e. Ministry of Health - and so hindered the development of capacity in the public health system. However, there have been other notable successes where medical programmes were carefully aligned with overarching campaign objectives which promoted the credibility and capacity of the host nation.

The Case studies.

Open the Haiti case study report

(27 June 2012)
Open the Afghanistan case study report

(17 December 2013)
Open the Lybia case study report

(18 December 2013)
Open the Kosovo case study report

(16 January 2014)
jallc@jallc.nato.int +351 21 771 7007/8/9