Fragile, handle with care: Refining a key concept for global health and development
MetadataShow full item record
Diaconu, K., Witter, S., Dakessian, A., Loffreda, G. and Ager, A. (2023) ‘Fragile, handle with care: refining a key concept for global health and development’, BMJ Global Health, 8(6), p. e012956. Available at: https://doi.org/10.1136/bmjgh-2023-012956.
Summary box In the development sphere, the term ‘fragile’ has generally been used as a pejorative label to represent ‘fragile and conflict-affected states’ with chronic governance challenges. Beginning with the formulation of the OECD’s multidimensional framing of fragility, a broader use of the term is emerging, which is of potential utility in the field of global health. Evidence from a series of studies addressing non-communicable disease and mental health provision—both of which require continuity of care and long-term investments into health service delivery and capacity—informs a ‘fragility for health’ framework consistent with this evolving understanding of fragility. This framework identifies two domains that warrant more intense, politically sensitive study: political economy and financing for health services delivery and community engagement in shaping systems for health. Consideration of these domains will critically inform health interventions in contexts of fragility.