Fragile, handle with care: Refining a key concept for global health and development

Abstract

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.