Major global health initiatives have come to recognize that their potential for success is inherently tied to the nature and performance of local political institutions and governance. Civil conflict, the rule of law, and the adequacy of state institutions to provide basic public goods are increasingly defining the trajectories of virtually all health-related indicators including whether a country will meet its MDG goals.
Significantly, efforts to improve security and governance have increasingly looked to the provision of public goods, including health services, as a potential mechanism for political reconciliation and improved governance. Given the humanitarian, politically privileged nature of health services, their provision could, in some circumstances, be used to build trust and ultimately the legitimacy of accords or state institutions.
However, despite the growing recognition health service provision and governance are inextricably linked, there remains a paucity of analytic insight into their detailed interaction in different epidemiologic and political settings. Moreover, virtually all academic global health programs confine their activities to areas of relative stability and good governance. This presentation will challenge this approach and suggest that the academic community must, at some level, address the political and governance challenges inherent in the provision of essential global health services.